Provider Demographics
NPI:1609876283
Name:SIMONS, DANE D (MD)
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:D
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 1:1120 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3541
Mailing Address - Country:US
Mailing Address - Phone:979-245-5721
Mailing Address - Fax:979-245-1482
Practice Address - Street 1:1120 AVENUE G
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3541
Practice Address - Country:US
Practice Address - Phone:979-245-5721
Practice Address - Fax:979-245-1482
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2334208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127045601Medicaid
TXF39627Medicare UPIN
TX127045601Medicaid