Basic Information
| Provider Information | |||||||||
| NPI: | 1285602094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMMS | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3717 75TH AVENUE CT NW | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983358404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532288517 | ||||||||
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| Practice Location | |||||||||
| Address1: | MADIGAN ARMY MEDICAL CENTER | ||||||||
| Address2: | 9040 REID ST., ATTN: MCHJ-QCR | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682252 | ||||||||
| FaxNumber: | 2539683278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00018512 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.