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General NPI Number Information
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NPI Number | 1821409731
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Entity Type | Individual
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Provider Name | DAVID SIMMONS MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 100 MULLINS DR STE C1
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City | LEBANON
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State | OR
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Zip | 97355-2868
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Country | US
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Telephone | 541-451-7450
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1189
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City | CORVALLIS
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State | OR
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Zip | 97339-1189
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD17706
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD177006
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | MD177006
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License Number State | OR
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