Provider Demographics
NPI:1497831796
Name:SIMMONS' PODIATRY, P.A.
Entity Type:Organization
Organization Name:SIMMONS' PODIATRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-728-1996
Mailing Address - Street 1:1861 ADMIRALTY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5209
Mailing Address - Country:US
Mailing Address - Phone:321-728-1996
Mailing Address - Fax:321-406-1026
Practice Address - Street 1:1861 ADMIRALTY BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5209
Practice Address - Country:US
Practice Address - Phone:321-728-1996
Practice Address - Fax:321-728-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 0001472213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480002763OtherRAILROAD MEDICARE
FL87795AOtherFIRST COAST SERVICE
FL87795AOtherFIRST COAST SERVICE