Healthcare Provider Details

I. General information

NPI: 1841285962
Provider Name (Legal Business Name): JOHN PAUL SIMMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 COTTONWOOD DR
ALAMOGORDO NM
88310-8219
US

IV. Provider business mailing address

108 COTTONWOOD DR
ALAMOGORDO NM
88310-8219
US

V. Phone/Fax

Practice location:
  • Phone: 505-434-0901
  • Fax: 505-437-1992
Mailing address:
  • Phone: 505-434-0901
  • Fax: 505-437-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2001-311
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: