Healthcare Provider Details

I. General information

NPI: 1598762577
Provider Name (Legal Business Name): ERIC WILLIAM SIMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 N HENRIETTA ST
EFFINGHAM IL
62401-1788
US

IV. Provider business mailing address

912 N HENRIETTA ST
EFFINGHAM IL
62401-1788
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-3337
  • Fax: 217-342-3337
Mailing address:
  • Phone: 312-775-1100
  • Fax: 312-775-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036100494
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number19686
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number063457
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-48514
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number53651
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: