Provider Demographics
NPI:1316141849
Name:SIMMONS, SHERRY D (MD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:D
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 PARSLEY LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7027
Mailing Address - Country:US
Mailing Address - Phone:217-698-8607
Mailing Address - Fax:217-698-8643
Practice Address - Street 1:4525 WABASH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7037
Practice Address - Country:US
Practice Address - Phone:217-698-8607
Practice Address - Fax:217-698-8643
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI07874Medicare UPIN