Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD430472 | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD430472 | PA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD430472 | PA |
NPI | 1336366467 |
---|---|
Provider Name | Dr. Barry Brent Simmons JR. |
First Address | Philadelphia, PA 19102-1320 |
Second Address | Philadelphia, PA 19127-2123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 16/07/2021 |