Provider Demographics
NPI:1447388343
Name:SIMMS, HARRY S (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:S
Last Name:SIMMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-1449
Mailing Address - Country:US
Mailing Address - Phone:707-869-5977
Mailing Address - Fax:707-869-5983
Practice Address - Street 1:652 PETALUMA AVE STE H
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4266
Practice Address - Country:US
Practice Address - Phone:707-823-3166
Practice Address - Fax:707-869-5983
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30706207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861809501Medicaid
CA00G307060Medicaid
CA751113Medicare Oscar/Certification
F13492Medicare UPIN