Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | D64657 | MD |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | LL33186 | SC |
N | 207YP0228X | Pediatric Otolaryngology | 33186 | SC |
Y | 208200000X | Surgeon | 33186 | SC |
Y | 208600000X | Surgeon | 33186 | SC |
NPI | 1992723183 |
---|---|
Provider Name | Dr. Oliver P. Simmons |
First Address | Lexington, SC 29072-9159 |
Second Address | Lexington, SC 29072-9159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 27/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
331867 | (05) | SC |
I67067 | (02) | MD |