Provider Demographics
NPI:1346418167
Name:SIMMONS, DAVID JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JACOB
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 1:300 TWINING ST BLDG 760
Mailing Address - Street 2:42 MDG/SGP
Mailing Address - City:MAXWELL AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6027
Mailing Address - Country:US
Mailing Address - Phone:334-953-3712
Mailing Address - Fax:334-953-8296
Practice Address - Street 1:300 TWINING ST BLDG 760
Practice Address - Street 2:42 MDG/SGP
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6027
Practice Address - Country:US
Practice Address - Phone:334-953-3712
Practice Address - Fax:334-953-8296
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0618582083A0100X
FLME1049522083P0901X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program