Healthcare Provider Details

I. General information

NPI: 1700973351
Provider Name (Legal Business Name): JAMES M SIMMERING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 STATE ROUTE 162 SUITE 120
MARYVILLE IL
62062-8553
US

IV. Provider business mailing address

6854 PARKER RD
FLORISSANT MO
63033-5313
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-1122
  • Fax: 618-288-1144
Mailing address:
  • Phone: 314-286-6988
  • Fax: 314-868-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036067473
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: