Provider Demographics
NPI:1598762577
Name:SIMONS, ERIC WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:SIMONS
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 1:100 MEDICAL PKWY
Mailing Address - Street 2:STE A
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2614
Mailing Address - Country:US
Mailing Address - Phone:712-265-2700
Mailing Address - Fax:712-263-1777
Practice Address - Street 1:100 MEDICAL PKWY STE A
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2614
Practice Address - Country:US
Practice Address - Phone:712-265-2700
Practice Address - Fax:712-263-1777
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19686207V00000X
GA063457207V00000X
MN53651207VX0000X
IAMD-48514207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00345214OtherRR MEDICARE NUMBER
ILCE9335OtherRR GROUP NUMBER
PAHA24830Medicare UPIN
ILK31289Medicare PIN
IL207988OtherMEDICARE GRP NUMBER
IL036100494Medicaid
IL06132036OtherBCBS