Provider Demographics
NPI:1710013859
Name:SIMMONS, RICHARD ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 ADMIRALTY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5209
Mailing Address - Country:US
Mailing Address - Phone:321-728-1996
Mailing Address - Fax:321-406-1026
Practice Address - Street 1:1861 ADMIRALTY BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5209
Practice Address - Country:US
Practice Address - Phone:321-728-1996
Practice Address - Fax:321-406-1026
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1472213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00142795OtherRAILROAD MEDICARE
FLPO 1472OtherSTATE LICENSE NUMBER
FLT11551Medicare UPIN
FLPO 1472OtherSTATE LICENSE NUMBER