Healthcare Provider Details

I. General information

NPI: 1912438300
Provider Name (Legal Business Name): ALLEN J SIMMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PARK ST
BOWLING GREEN KY
42101-1742
US

IV. Provider business mailing address

201 PARK ST
BOWLING GREEN KY
42101-1742
US

V. Phone/Fax

Practice location:
  • Phone: 270-783-3343
  • Fax: 270-780-0476
Mailing address:
  • Phone: 270-781-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number60169
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number157050
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0116038432
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number60169
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: