MEDICARE: JOHN J SIMMER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	34081	MN
2	207Y00000X	Otolaryngology Physician	60167500	WA

General Provider Information

NPI Number	:	1174594881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J SIMMER M.D.

Provider Business Mailing Address
First Line	:	7424 BRIDGEPORT WAY WEST.
Second Line	:	SUITE 305
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3402
Country	:	US
Telephone Number	:	253-301-6960
Fax Number	:	253-582-5938

Provider Business Practice Location Address
First Line	:	7424 BRIDGEPORT WAY WEST.
Second Line	:	SUITE 305
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3402
Country	:	US
Telephone Number	:	253-301-6960
Fax Number	:	253-582-5938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	04/16/2012

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