Provider Demographics
NPI:1619971637
Name:SIMMONS, BRYAN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:PAUL
Last Name:SIMMONS
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 1:176 S BELLEVUE BLVD
Mailing Address - Street 2:SUITE 603
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3424
Mailing Address - Country:US
Mailing Address - Phone:901-516-8231
Mailing Address - Fax:901-516-8249
Practice Address - Street 1:176 S BELLEVUE BLVD
Practice Address - Street 2:SUITE 603
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3424
Practice Address - Country:US
Practice Address - Phone:901-516-8231
Practice Address - Fax:901-516-8249
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 15503207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE0615OtherAR LICENSE
TN3020692Medicaid
3020694Medicare ID - Type Unspecified
TN3020692Medicaid