MEDICARE: DR. BARRY BRENT SIMMONS JR. 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	MD430472	PA
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	MD430472	PA
3	207Q00000X	Family Medicine Physician	MD430472	PA

General Provider Information

NPI Number	:	1336366467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY BRENT SIMMONS JR. M.D.

Provider Business Mailing Address
First Line	:	1601 CHERRY ST
Second Line	:	SUITE 11511
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1320
Country	:	US
Telephone Number	:	215-255-7822
Fax Number	:	215-255-7825

Provider Business Practice Location Address
First Line	:	10 SHURS LN
Second Line	:	SUITE 301
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2123
Country	:	US
Telephone Number	:	215-482-1234
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/16/2021

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