Provider Demographics
NPI:1578604740
Name:SIMMS, SAM RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:RAY
Last Name:SIMMS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:200 FAWN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LINN CREEK
Mailing Address - State:MO
Mailing Address - Zip Code:65052-2215
Mailing Address - Country:US
Mailing Address - Phone:573-346-5256
Mailing Address - Fax:573-346-5256
Practice Address - Street 1:100 ST. MARY'S MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101
Practice Address - Country:US
Practice Address - Phone:573-761-7011
Practice Address - Fax:573-636-4819
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MO108182207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31881OtherBNDD NUMBER
MO108182OtherMISSOURI MEDICAL LICENSE
MOBS3724829OtherDEA NUMBER
MOBS3724829OtherDEA NUMBER