Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 19094 | NH |
NPI | 1013379262 |
---|---|
Provider Name | Dr. Brian Simmons |
First Address | Lebanon, NH 03766-1937 |
Second Address | Lebanon, NH 03766-1937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2016 |
Last Update Date | 16/07/2020 |