MEDICARE: DR. DEMETRIUS ANTOINE SIMMONS DO

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	207P00000X	Emergency Medicine Physician	28328	MS
2	207QS0010X	Sports Medicine (Family Medicine) Physician	3208	AL
3	390200000X	Student in an Organized Health Care Education/Training Program		MS
4	207P00000X	Emergency Medicine Physician	DO.3208	AL

General Provider Information

NPI Number	:	1932669546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEMETRIUS ANTOINE SIMMONS DO

Provider Business Mailing Address
First Line	:	2451 UNIVERSITY HOSPITAL DR RM 714
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36617-2300
Country	:	US
Telephone Number	:	251-445-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 HILLCREST RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-5306
Country	:	US
Telephone Number	:	251-341-3800
Fax Number	:

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	10/13/2023

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