Provider Demographics
NPI:1841285962
Name:SIMMONS, JOHN PAUL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
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 1:108 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8219
Mailing Address - Country:US
Mailing Address - Phone:505-434-0901
Mailing Address - Fax:505-437-1992
Practice Address - Street 1:108 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8219
Practice Address - Country:US
Practice Address - Phone:505-434-0901
Practice Address - Fax:505-437-1992
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-3112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM019849OtherBC/BS
NM130026146OtherRR MEDICARE
NM50662OtherPRESBYTERIAN
NMP7672Medicaid
NM88310A003OtherWPS TRICARE
NMNM019849OtherBC/BS
NM50662OtherPRESBYTERIAN