Provider Demographics
NPI:1689760944
Name:SIMMONS, JOHN R (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:SIMMONS
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 1:793 EASTERN BYP
Mailing Address - Street 2:G2
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2422
Mailing Address - Country:US
Mailing Address - Phone:859-626-0074
Mailing Address - Fax:859-626-3265
Practice Address - Street 1:793 EASTERN BYP
Practice Address - Street 2:G2
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2422
Practice Address - Country:US
Practice Address - Phone:859-626-0074
Practice Address - Fax:859-626-3265
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY030502085R0001X
OH34.0087322085R0001X
ND103112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082508Medicaid
KY7100024870Medicaid
OHPO1231527OtherRR MEDICARE
OH0082508Medicaid
KYP00421305Medicare PIN
KY0169Medicare PIN
KY0980Medicare PIN
OHPO1231527OtherRR MEDICARE