Basic Information
| Provider Information | |||||||||
| NPI: | 1487815684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 EDWARDS MILL RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197815600 | ||||||||
| FaxNumber: | 9198636821 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 EDWARDS MILL RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197815600 | ||||||||
| FaxNumber: | 9198636821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2008 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 572 | NC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | 572 | NC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213EP1101X | 572 | NC | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
No ID Information.