Provider Demographics
NPI:1124146113
Name:SIMMS, RALPH EDWARD SR (DO)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EDWARD
Last Name:SIMMS
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT 1 BOX 85
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:WV
Mailing Address - Zip Code:25985
Mailing Address - Country:US
Mailing Address - Phone:304-934-6400
Mailing Address - Fax:304-934-7400
Practice Address - Street 1:6435 HARPER RD
Practice Address - Street 2:
Practice Address - City:GLEN DANIEL
Practice Address - State:WV
Practice Address - Zip Code:25844
Practice Address - Country:US
Practice Address - Phone:304-934-6400
Practice Address - Fax:304-934-7400
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1206207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5630471000Medicaid
WV1205948528OtherCOMPANY NPI FOX SYSTEMS
WV5630471000Medicaid
WV1205948528OtherCOMPANY NPI FOX SYSTEMS