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NPI Code Detail

MEDICARE: MR. THOMAS GODON SIMMONS P.A.

MEDICARE: MR. THOMAS GODON SIMMONS P.A.
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
1363AS0400XSurgical Physician AssistantPA-147AR

General Provider Information

NPI Number : 1366422404
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS GODON SIMMONS P.A.
Provider Business Mailing Address
First Line : 3276 N NORTHHILLS BLVD
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4005
Country : US
Telephone Number : 479-587-1114
Fax Number : 479-587-1119
Provider Business Practice Location Address
First Line : 3276 N NORTHHILLS BLVD
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4005
Country : US
Telephone Number : 479-587-1114
Fax Number : 479-587-1119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2006
Last Update Date : 07/08/2007

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