Provider Demographics
NPI:1912940693
Name:SIMMONS, GARRICK R (MD)
Entity Type:Individual
Prefix:MR
First Name:GARRICK
Middle Name:R
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 TINA AVE, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808
Mailing Address - Country:US
Mailing Address - Phone:406-728-3366
Mailing Address - Fax:406-728-0651
Practice Address - Street 1:2875 TINA AVE, SUITE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808
Practice Address - Country:US
Practice Address - Phone:406-728-3366
Practice Address - Fax:406-728-0651
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9926208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology