Individual
JON L SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2820 ROOSEVELT ROAD, MARINETTE, WI 54143-3834
(715) 735-5225
(715) 735-5388
Mailing address
PO BOX 1866, GREEN BAY, WI 54305-1866
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37092
WI
207QA0505X
Adult Medicine Physician
4301089159
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32167300
—
WI
05
—
4957216
—
MI
Enumeration date
06/08/2006
Last updated
05/31/2018
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