Provider Demographics
NPI:1235123449
Name:SIMMS, SCOTT ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANDREW
Last Name:SIMMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4035
Mailing Address - Country:US
Mailing Address - Phone:940-382-9636
Mailing Address - Fax:940-382-1554
Practice Address - Street 1:700 W OAK ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4035
Practice Address - Country:US
Practice Address - Phone:940-382-9636
Practice Address - Fax:940-382-1554
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2012-12-12
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
TXL6639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160166801Medicaid
TXH91520Medicare UPIN
TX00947PMedicare ID - Type Unspecified
TX00947PYKPWMedicare PIN