Provider Demographics
NPI:1780878363
Name:SIMMONS, PHILLIP RAY
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:RAY
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 1:902 MILAM ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-4735
Mailing Address - Country:US
Mailing Address - Phone:903-793-5484
Mailing Address - Fax:
Practice Address - Street 1:902 MILAM ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4735
Practice Address - Country:US
Practice Address - Phone:903-793-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies