Provider Demographics
NPI:1053582338
Name:WARREN L. SIMMONDS, DPM
Entity type:Organization
Organization Name:WARREN L. SIMMONDS, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QWNER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-866-9608
Mailing Address - Street 1:1111 KANE CONCOURSE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BAY HARBOR ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2039
Mailing Address - Country:US
Mailing Address - Phone:305-866-9608
Mailing Address - Fax:305-866-1750
Practice Address - Street 1:1111 KANE CONCOURSE
Practice Address - Street 2:SUITE 111
Practice Address - City:BAY HARBOR ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33154-2039
Practice Address - Country:US
Practice Address - Phone:305-866-9608
Practice Address - Fax:305-866-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO345332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1057020001Medicare NSC
FL87169Medicare PIN
FLT91469Medicare UPIN