Provider Demographics
NPI:1619594819
Name:SIMONS, JEFFREY EVERETT (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EVERETT
Last Name:SIMONS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7216
Mailing Address - Country:US
Mailing Address - Phone:619-272-1570
Mailing Address - Fax:
Practice Address - Street 1:1600 NW 114TH ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7071
Practice Address - Country:US
Practice Address - Phone:619-272-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAEL-0001208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice