Provider Demographics
NPI:1396737607
Name:SIMONS, ROGER D (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:SIMONS
Suffix:
Gender:M
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-0550
Mailing Address - Country:US
Mailing Address - Phone:870-453-2274
Mailing Address - Fax:870-453-2276
Practice Address - Street 1:111 MAIN PL
Practice Address - Street 2:SUITE #3
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634
Practice Address - Country:US
Practice Address - Phone:870-453-2274
Practice Address - Fax:870-453-2276
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
02667800001OtherDMERC REGION C
AR54863Medicare ID - Type Unspecified
D04912Medicare UPIN