Provider Demographics
NPI:1275094856
Name:SIMMONS, TRAVIS CARLISLE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:CARLISLE
Last Name:SIMMONS
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 1:952 GRUENE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3934
Mailing Address - Country:US
Mailing Address - Phone:830-203-6198
Mailing Address - Fax:830-626-9922
Practice Address - Street 1:952 GRUENE RD STE 150
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3934
Practice Address - Country:US
Practice Address - Phone:830-203-6198
Practice Address - Fax:830-626-9922
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0065665207Q00000X
390200000X
TXT6041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000173574Medicaid