Provider Demographics
NPI:1770862567
Name:SIMMONS, REGINOLD LEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINOLD
Middle Name:LEVI
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 1:400 TEDDER ROAD
Mailing Address - Street 2:
Mailing Address - City:CENTURY
Mailing Address - State:FL
Mailing Address - Zip Code:32535
Mailing Address - Country:US
Mailing Address - Phone:850-256-1784
Mailing Address - Fax:850-256-1319
Practice Address - Street 1:400 TEDDER ROAD
Practice Address - Street 2:
Practice Address - City:CENTURY
Practice Address - State:FL
Practice Address - Zip Code:32535
Practice Address - Country:US
Practice Address - Phone:850-256-1784
Practice Address - Fax:850-256-1319
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35623208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice