Provider Demographics
NPI:1053358309
Name:SIMMS-MACKEY, PAMELA JANINE (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JANINE
Last Name:SIMMS-MACKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1033
Mailing Address - Country:US
Mailing Address - Phone:510-428-3129
Mailing Address - Fax:510-547-2702
Practice Address - Street 1:5220 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1033
Practice Address - Country:US
Practice Address - Phone:510-428-3129
Practice Address - Fax:510-547-2702
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054758208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA547580Medicaid
CAGR0095800OtherMEDICAL