MEDICARE: DEJA MARIE SIMMONS PA-C

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	363AS0400X	Surgical Physician Assistant	2076	CO
2	363AS0400X	Surgical Physician Assistant	PA 9104225	FL

General Provider Information

NPI Number	:	1275751315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEJA MARIE SIMMONS PA-C

Provider Business Mailing Address
First Line	:	8007 E LEHIGH DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-1534
Country	:	US
Telephone Number	:	303-808-6282
Fax Number	:	720-519-1471

Provider Business Practice Location Address
First Line	:	4950 S YOSEMITE ST
Second Line	:	F2-242
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-1349
Country	:	US
Telephone Number	:	303-808-6282
Fax Number	:	720-519-1471

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	12/27/2013

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