Provider Demographics
NPI:1902218043
Name:SIMMONS, CAMERON BYRNE (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:BYRNE
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 1:1430 TULANE AVE # 8016
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-1940
Mailing Address - Fax:504-988-8252
Practice Address - Street 1:621 S NEW BALLAS RD STE 6017B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8274
Practice Address - Country:US
Practice Address - Phone:314-251-7840
Practice Address - Fax:314-251-4173
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018016024207Q00000X, 207QH0002X
LA334316207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200921OtherRESIDENT TRAINING LICENSE
NCAC5385578-R125OtherDEA