Provider Demographics
NPI:1457453060
Name:SIMMONDS, GAREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GAREY
Middle Name:S
Last Name:SIMMONDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15721 N GREENWAY HAYDEN LOOP
Mailing Address - Street 2:#201
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1650
Mailing Address - Country:US
Mailing Address - Phone:480-905-9211
Mailing Address - Fax:480-905-0504
Practice Address - Street 1:15721 N GREENWAY HAYDEN LOOP
Practice Address - Street 2:#201
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1650
Practice Address - Country:US
Practice Address - Phone:480-905-9211
Practice Address - Fax:480-905-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23958208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ370453-01OtherAHCSS
AZ370453-01OtherAHCSS
AZ115055Medicare PIN