Provider Demographics
NPI:1851308506
Name:SIMMONS, CHARLES ERRINGTON III (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ERRINGTON
Last Name:SIMMONS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1771 EDGEWOOD AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208
Mailing Address - Country:US
Mailing Address - Phone:904-766-1106
Mailing Address - Fax:904-766-1751
Practice Address - Street 1:1771 EDGEWOOD AVE
Practice Address - Street 2:STE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208
Practice Address - Country:US
Practice Address - Phone:904-766-1106
Practice Address - Fax:904-766-1751
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME36134208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039575700Medicaid
FL039575700Medicaid