Provider Demographics
NPI:1922068733
Name:SIMMONS, DONOVAN MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:MITCHELL
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:PO BOX 4268
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-4268
Mailing Address - Country:US
Mailing Address - Phone:512-306-1903
Mailing Address - Fax:512-306-0107
Practice Address - Street 1:12221 N MO PAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-306-1903
Practice Address - Fax:512-306-0107
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158085405Medicaid
TXP00935759OtherRRMCARE THRU HCMS
TX10046385OtherAMERIGROUP
TX158085406Medicaid
TX8V0511OtherBCBS
TX158085405Medicaid
TX158085406Medicaid
TX8V0511OtherBCBS