Individual
BRYAN D. SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
555 S SHORELINE BLVD, SUITE 101, CORPUS CHRISTI, TX 78401-3552
(361) 887-9456
(361) 887-7300
Mailing address
555 S SHORELINE BLVD, SUITE 101, CORPUS CHRISTI, TX 78401-3552
(361) 887-9456
(361) 887-7300
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
0053646
TX
247200000X
Other Technician
0053646
TX
332B00000X
Durable Medical Equipment & Medical Supplies
0053646
TX
332BC3200X
Customized Equipment (DME)
Primary
0053646
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154894301
—
TX
05
—
154894302
—
TX
05
—
154894303
—
TX
05
—
154894304
—
TX
Enumeration date
06/27/2006
Last updated
05/25/2013
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