Provider Demographics
NPI:1669416780
Name:SIMMONS, SARAH VANARSDALE (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:VANARSDALE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13506 CATALANO CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5315
Mailing Address - Country:US
Mailing Address - Phone:832-534-2770
Mailing Address - Fax:
Practice Address - Street 1:13506 CATALANO CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5315
Practice Address - Country:US
Practice Address - Phone:832-534-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188624401Medicaid
GAP00401491Medicare PIN
TX188624401Medicaid
TX8J3877Medicare PIN