Healthcare Provider Details

I. General information

NPI: 1548271448
Provider Name (Legal Business Name): RYAN CURTIS SIMMONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PEGRAM DR
TUPELO MS
38801-6322
US

IV. Provider business mailing address

PO BOX 2180
TUPELO MS
38803-2180
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-7540
  • Fax: 662-844-1113
Mailing address:
  • Phone: 662-844-6513
  • Fax: 662-844-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number18465
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number18465
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number18465
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: