Provider Demographics
NPI:1417045329
Name:SIMMONS, JERALD HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:HOWARD
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:PO BOX 16820
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6820
Mailing Address - Country:US
Mailing Address - Phone:281-240-3773
Mailing Address - Fax:281-239-6268
Practice Address - Street 1:2201 W HOLCOMBE BLVD
Practice Address - Street 2:STE 325
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2096
Practice Address - Country:US
Practice Address - Phone:713-668-4100
Practice Address - Fax:713-668-4105
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK76142084N0400X, 2084N0600X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047090801Medicaid
TX047090801Medicaid
GA130019874Medicare PIN
TX88V292Medicare PIN