Healthcare Provider Details

I. General information

NPI: 1891770723
Provider Name (Legal Business Name): KYLE EDWIN SIMMERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E HIGHWAY 20 PEDIATRIC DEPARTMENT
NICEVILLE FL
32578-8826
US

IV. Provider business mailing address

2001 E. HIGHWAY 20 PEDIATRIC DEPARTMENT
NICEVILLE FL
32578
US

V. Phone/Fax

Practice location:
  • Phone: 850-897-4400
  • Fax: 850-897-0623
Mailing address:
  • Phone: 850-897-4400
  • Fax: 850-897-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME86100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: