Provider Demographics
NPI:1063892990
Name:SIMMONS, ADAM (DPM)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-1740
Mailing Address - Country:US
Mailing Address - Phone:813-566-2079
Mailing Address - Fax:
Practice Address - Street 1:708 S MILL ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-1740
Practice Address - Country:US
Practice Address - Phone:813-566-2079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4033213E00000X
MEPOD1107213E00000X
WAPO61212546213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist