Basic Information
| Provider Information | |||||||||
| NPI: | 1487861688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | RAHMAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6451 N FEDERAL HWY | ||||||||
| Address2: | STE. 800 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005865022 | ||||||||
| FaxNumber: | 8668897833 | ||||||||
| Practice Location | |||||||||
| Address1: | 6451 N FEDERAL HWY | ||||||||
| Address2: | STE. 800 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005865022 | ||||||||
| FaxNumber: | 8668897833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 35.089578 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 036122320 | MO | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2748727 | 05 | OH | MEDICAID |