Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 14960 | AL |
NPI | 1013904507 |
---|---|
Provider Name | Bernis A Simmons |
First Address | Birmingham, AL 35235-3430 |
Second Address | Birmingham, AL 35235-3430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E23370 | (02) | AL |