Healthcare Provider Details

I. General information

NPI: 1992723183
Provider Name (Legal Business Name): OLIVER P. SIMMONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 SW 27TH AVE
MIAMI FL
33145-2418
US

IV. Provider business mailing address

1790 SW 27TH AVE
MIAMI FL
33145-2418
US

V. Phone/Fax

Practice location:
  • Phone: 305-330-2434
  • Fax:
Mailing address:
  • Phone: 305-330-2434
  • Fax: 305-330-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME138195
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberME138195
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME138195
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: