Provider Demographics
NPI:1518956887
Name:SIMKINS, JODI S (MD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:S
Last Name:SIMKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W CAMINO REAL
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-391-2770
Mailing Address - Fax:561-391-2930
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 207
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-391-2770
Practice Address - Fax:561-391-2930
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049159207R00000X
FLME49159208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
12809AMedicare ID - Type Unspecified