Provider Demographics
NPI:1942582929
Name:SIMMONS, JOHN CALEB (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CALEB
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6210 E HIGHWAY 290 STE 420
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9569
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:3816 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7048
Practice Address - Country:US
Practice Address - Phone:512-443-1311
Practice Address - Fax:512-406-6266
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2019-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10039761207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360710305Medicaid
TX360710306Medicaid