Provider Demographics
NPI:1457399883
Name:SIMMONS, EDWARD DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DONALD
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 1:235 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1401
Mailing Address - Country:US
Mailing Address - Phone:716-882-0035
Mailing Address - Fax:716-882-3032
Practice Address - Street 1:235 NORTH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1401
Practice Address - Country:US
Practice Address - Phone:716-882-0035
Practice Address - Fax:716-882-3032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177174207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE16823Medicare UPIN
NYBB4385Medicare ID - Type Unspecified