Provider Demographics
NPI:1396952420
Name:DAVID B SIMMONS MD PA
Entity type:Organization
Organization Name:DAVID B SIMMONS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-299-5300
Mailing Address - Street 1:DAVID B SIMMONS MD PA
Mailing Address - Street 2:320 1ST STREET, N
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881
Mailing Address - Country:US
Mailing Address - Phone:863-299-5300
Mailing Address - Fax:863-299-5322
Practice Address - Street 1:DAVID B SIMMONS MD PA
Practice Address - Street 2:320 1ST STREET, N
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881
Practice Address - Country:US
Practice Address - Phone:863-299-5300
Practice Address - Fax:863-299-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60962207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF83686Medicare UPIN
FLK7087Medicare ID - Type UnspecifiedGROUP MEDICARE
FL25397YMedicare ID - Type UnspecifiedMEDICARE-PERSONAL