Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 4150 | SC |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4150 | SC |
NPI | 1275586950 |
---|---|
Provider Name | Dr. Jeffrey James Simmons |
First Address | Greenville, SC 29615-6301 |
Second Address | Greenville, SC 29615-6301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 13/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V08920 | (02) | |
ZX4150 | (05) | SC |