Provider Demographics
NPI:1588670517
Name:SIMMONS, GARY ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALFRED
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:4401 HARRISON BOULEVARD
Practice Address - Street 2:MCKAY DEE HOSPITAL
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT83-170245-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1502954OtherUMWA
UT36519OtherDESERET MUTUAL
UT8597445OtherWORKERS COMP. FUND
UTPRA05805OtherMOLINA
UT107006049101OtherIHC
UT2090168OtherUNITED HEALTHCARE
UT37819OtherPEHP
UT870545614SI2OtherEDUCATORS MUTUAL
NV100501264Medicaid
AZ822149Medicaid
UTQM0000075886OtherALTIUS
WY108062800Medicaid
UT3236OtherHEALTHY U
ID804070000Medicaid
ID804070000Medicaid
UTQM0000075886OtherALTIUS
UT3236OtherHEALTHY U