MEDICARE: LARY SIMMS DO, WPH

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	207ZF0201X	Forensic Pathology Physician	880	NV

General Provider Information

NPI Number	:	1518317023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARY SIMMS DO, WPH

Provider Business Mailing Address
First Line	:	1704 PINTO LANE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106
Country	:	US
Telephone Number	:	702-455-3210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1704 PINTO LANE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106
Country	:	US
Telephone Number	:	702-455-3210
Fax Number	:

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

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/28/2016

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Directions to “ LARY SIMMS DO, WPH” Practice Location

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