Basic Information
| Provider Information | |||||||||
| NPI: | 1588939979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | DAVIS | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4245 ROOSEVELT WAY NE | ||||||||
| Address2: | BOX 354760 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981056008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065985323 | ||||||||
| FaxNumber: | 2065986186 | ||||||||
| Practice Location | |||||||||
| Address1: | 4245 ROOSEVELT WAY NE | ||||||||
| Address2: | BOX 354760 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981056008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065985323 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2012 | ||||||||
| LastUpdateDate: | 03/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ML 60285824 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.