Provider Demographics
NPI:1285602094
Name:SIMMS, ROGER S (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:S
Last Name:SIMMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3717 75TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8404
Mailing Address - Country:US
Mailing Address - Phone:253-228-8517
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:9040 REID ST., ATTN: MCHJ-QCR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WAMD00018512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A20484Medicare UPIN