Provider Demographics
NPI:1023114832
Name:SIMMONS, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
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 1:3702 S TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3624
Mailing Address - Country:US
Mailing Address - Phone:970-207-9773
Mailing Address - Fax:970-207-1893
Practice Address - Street 1:3702 S TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3624
Practice Address - Country:US
Practice Address - Phone:970-207-9773
Practice Address - Fax:970-207-1893
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22917207RG0100X
WY8372A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01229178Medicaid
CO826103111OtherMEDICARE RAILROAD
CO01229178Medicaid
CO826103111OtherMEDICARE RAILROAD