Provider Demographics
NPI:1922430008
Name:SIMMON, LISA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:SIMMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:RAULS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5555 W. THUNDERBIRD
Mailing Address - Street 2:BANNER THUNDERBIRD MEDICAL CENTER
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-865-2627
Mailing Address - Fax:602-865-2632
Practice Address - Street 1:5555 W. THUNDERBIRD
Practice Address - Street 2:BANNER THUNDERBIRD MEDICAL CENTER
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-865-2627
Practice Address - Fax:602-865-2632
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50672208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine