Individual
GARY EDWARD SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4005 24TH ST, LUBBOCK, TX 79410-1835
(806) 792-2767
(888) 861-8858
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3194
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
L1748
TX
2085U0001X
Diagnostic Ultrasound Physician
L1748
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1236695
FIRST HEALTH
—
01
—
128599100
FIRSTCARE
TX
05
—
151630401
—
TX
05
—
26050561
—
NM
01
—
300132403
RAILROAD MEDICARE
—
01
—
8G1350
BLUE CROSS
TX
Enumeration date
06/21/2005
Last updated
02/22/2022
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