Provider Demographics
NPI:1790787901
Name:SIMMONS, DAVID RW (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RW
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 1:850 TRAFALGAR CT
Mailing Address - Street 2:STE 420
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4141
Mailing Address - Country:US
Mailing Address - Phone:407-478-0065
Mailing Address - Fax:407-478-0085
Practice Address - Street 1:850 TRAFALGAR CT
Practice Address - Street 2:STE 420
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4141
Practice Address - Country:US
Practice Address - Phone:407-478-0065
Practice Address - Fax:407-478-0085
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376186000Medicaid
FLF87807Medicare UPIN
FL376186000Medicaid