Healthcare Provider Details

I. General information

NPI: 1568547248
Provider Name (Legal Business Name): BRYAN A SIMMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 GREEN ST
CLAYMONT DE
19703-2052
US

IV. Provider business mailing address

3301 GREEN ST
CLAYMONT DE
19703-2052
US

V. Phone/Fax

Practice location:
  • Phone: 302-798-9755
  • Fax:
Mailing address:
  • Phone: 302-798-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC1002068
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: