Provider Demographics
NPI:1639142771
Name:SIMMS, TRACI D (MD)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:D
Last Name:SIMMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N 8TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8847
Mailing Address - Country:US
Mailing Address - Phone:970-245-1168
Mailing Address - Fax:970-242-4299
Practice Address - Street 1:2525 N 8TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-245-1168
Practice Address - Fax:970-242-4299
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO33124207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01331248Medicaid
COF74610Medicare UPIN
CO01331248Medicaid