Healthcare Provider Details

I. General information

NPI: 1053356055
Provider Name (Legal Business Name): TERRY ALAN SIMMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15604 PINEHURST DR STE 2
BASEHOR KS
66007-8234
US

IV. Provider business mailing address

15604 PINEHURST DR STE 2
BASEHOR KS
66007-8234
US

V. Phone/Fax

Practice location:
  • Phone: 913-728-2200
  • Fax: 913-728-2230
Mailing address:
  • Phone: 913-728-2200
  • Fax: 913-728-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0430750
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: