Provider Demographics
NPI:1245550292
Name:SIMMONS, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 NE 42ND ST
Mailing Address - Street 2:UNIT 302
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-4201
Mailing Address - Country:US
Mailing Address - Phone:954-822-3362
Mailing Address - Fax:954-933-2294
Practice Address - Street 1:681 NE 42ND ST
Practice Address - Street 2:UNIT 302
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4201
Practice Address - Country:US
Practice Address - Phone:954-822-3362
Practice Address - Fax:954-933-2294
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor