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NPI Code Detail

MEDICARE: DR. PAMELA JANINE SIMMS-MACKEY M.D.

MEDICARE: DR. PAMELA JANINE SIMMS-MACKEY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianA054758CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2GR0095800OTHERCAMEDICAL

General Provider Information

NPI Number : 1053358309
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAMELA JANINE SIMMS-MACKEY M.D.
Provider Business Mailing Address
First Line : 5220 CLAREMONT AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94618-1033
Country : US
Telephone Number : 510-428-3129
Fax Number : 510-547-2702
Provider Business Practice Location Address
First Line : 5220 CLAREMONT AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94618-1033
Country : US
Telephone Number : 510-428-3129
Fax Number : 510-547-2702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 07/18/2007

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