Provider Demographics
NPI:1619597200
Name:SIMMONS, RAYMOND (CNIM)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 S ULSTER ST STE 1225
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2696
Mailing Address - Country:US
Mailing Address - Phone:720-287-3039
Mailing Address - Fax:
Practice Address - Street 1:4600 S ULSTER ST STE 1225
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2696
Practice Address - Country:US
Practice Address - Phone:720-287-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3623246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic