Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | E-2598 | AR |
NPI | 1134219603 |
---|---|
Provider Name | Timothy Scott Simmons |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 25/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19602000010 | QUALCHOICE (01) | |
5L974 | BCBS (01) | |
H41935 | (02) | |
P00247354 | RAILROAD MEDICARE (01) |