Provider Demographics
NPI:1568502896
Name:SIMONS, NATHAN TREVOR (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:TREVOR
Last Name:SIMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5430
Mailing Address - Country:US
Mailing Address - Phone:979-836-2822
Mailing Address - Fax:979-836-1943
Practice Address - Street 1:601 MEDICAL PARKWAY
Practice Address - Street 2:SUITE D
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5430
Practice Address - Country:US
Practice Address - Phone:979-836-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206503901Medicaid
TX206503901Medicaid