Healthcare Provider Details

I. General information

NPI: 1043519853
Provider Name (Legal Business Name): JAMES SIMMONS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N FRESNO ST
FRESNO CA
93701-2302
US

IV. Provider business mailing address

5563 N BRENT AVE
FRESNO CA
93723-7658
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6500
  • Fax:
Mailing address:
  • Phone: 209-603-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A12478
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number20A12478
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A12478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: