Healthcare Provider Details

I. General information

NPI: 1518004142
Provider Name (Legal Business Name): CHARLES STERLING SIMMONS M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 JACKSON ST
MONROE LA
71201-0309
US

IV. Provider business mailing address

2308 HILLSIDE RD
RUSTON LA
71270-5980
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-1870
  • Fax: 318-966-1871
Mailing address:
  • Phone: 318-966-1870
  • Fax: 318-966-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberMD.017598
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: