Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | D30190 | MD |
NPI | 1104931328 |
---|---|
Provider Name | Mr. Michael Ross Simmons |
First Address | Timonium, MD 21093-3125 |
Second Address | Timonium, MD 21093-3125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D76590 | (02) |