Provider Demographics
NPI:1518004142
Name:SIMMONS, CHARLES STERLING (M D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STERLING
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2308 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5980
Mailing Address - Country:US
Mailing Address - Phone:318-966-1870
Mailing Address - Fax:318-966-1871
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-0309
Practice Address - Country:US
Practice Address - Phone:318-966-1870
Practice Address - Fax:318-966-1871
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.017598207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1339172Medicaid
LA1339174Medicaid
LA00113057OtherOFFICE OF GROUP BENEFITS
LA204405427OtherTRICARE
LA1339172Medicaid
LA1339174Medicaid