Provider Demographics
NPI:1578556601
Name:SIMMONS, DONALD RAE (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RAE
Last Name:SIMMONS
Suffix:
Gender:M
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:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-0723
Mailing Address - Country:US
Mailing Address - Phone:940-759-2226
Mailing Address - Fax:940-759-2385
Practice Address - Street 1:509 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252-2425
Practice Address - Country:US
Practice Address - Phone:940-759-2226
Practice Address - Fax:940-759-2385
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2010207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151641104Medicaid
TX130943702Medicaid
H59998Medicare UPIN
TX130943702Medicaid
TXTXB142603Medicare PIN