Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 22917 | CO |
N | 207RG0100X | Gastroenterologist | 8372A | WY |
NPI | 1023114832 |
---|---|
Provider Name | Robert A Simmons |
First Address | Fort Collins, CO 80525-3624 |
Second Address | Fort Collins, CO 80525-3624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01229178 | (05) | CO |
826103111 | MEDICARE RAILROAD (01) | CO |
D24174 | (02) | CO |