Healthcare Provider Details

I. General information

NPI: 1902218043
Provider Name (Legal Business Name): CAMERON BYRNE SIMMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 6017B
SAINT LOUIS MO
63141-8274
US

IV. Provider business mailing address

1430 TULANE AVE # 8016
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7840
  • Fax: 314-251-4173
Mailing address:
  • Phone: 504-988-1940
  • Fax: 504-988-8252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018016024
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number2018016024
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number334316
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: