Healthcare Provider Details

I. General information

NPI: 1619971637
Provider Name (Legal Business Name): BRYAN PAUL SIMMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S BELLEVUE BLVD SUITE 603
MEMPHIS TN
38104-3424
US

IV. Provider business mailing address

176 S BELLEVUE BLVD SUITE 603
MEMPHIS TN
38104-3424
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-8231
  • Fax: 901-516-8249
Mailing address:
  • Phone: 901-516-8231
  • Fax: 901-516-8249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD 15503
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: