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General NPI Number Information
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NPI Number | 1306105481
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Entity Type | Organization
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Legal Business Name | C WILTON SIMMONS JR MD PA
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 902 FROSTWOOD DR SUITE 244
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City | HOUSTON
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State | TX
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Zip | 77024-2420
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Country | US
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Telephone | 713-932-6467
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Fax | 713-932-0647
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Provider Business Mailing Address
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Address Line | 902 FROSTWOOD DR SUITE 244
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City | HOUSTON
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State | TX
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Zip | 77024-2420
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Country | US
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Telephone | 713-932-6467
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Fax | 713-932-0647
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. CLYDE WILTON SIMMONS JR.
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Credential |
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Telephone | 713-932-6467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | D7303
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License Number State | TX
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