Provider Demographics
NPI:1588735476
Name:SIMMS, ERIN JESSICA (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JESSICA
Last Name:SIMMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:JESSICA
Other - Last Name:SIMMS-EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:744 52ND ST
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1810
Mailing Address - Country:US
Mailing Address - Phone:510-428-3456
Mailing Address - Fax:510-450-5613
Practice Address - Street 1:744 52ND ST
Practice Address - Street 2:SUITE 4200
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1810
Practice Address - Country:US
Practice Address - Phone:510-428-3456
Practice Address - Fax:510-450-5613
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79837207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G798370Medicaid
CA00G798370Medicaid