Provider Demographics
NPI:1306105481
Name:C WILTON SIMMONS JR MD PA
Entity type:Organization
Organization Name:C WILTON SIMMONS JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:WILTON
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:713-932-6467
Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:SUITE 244
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-932-6467
Mailing Address - Fax:713-932-0647
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:SUITE 244
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:713-932-6467
Practice Address - Fax:713-932-0647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7303208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L598Medicare PIN