Healthcare Provider Details

I. General information

NPI: 1063635464
Provider Name (Legal Business Name): DANIEL J SIMMONDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E JEFFERSON BLVD
FORT WAYNE IN
46802-3114
US

IV. Provider business mailing address

1810 OLD LANTERN TRL
FORT WAYNE IN
46845-1421
US

V. Phone/Fax

Practice location:
  • Phone: 260-426-2644
  • Fax: 260-426-1914
Mailing address:
  • Phone: 260-637-9041
  • Fax: 260-426-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number01038691B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: