Provider Demographics
NPI:1124703822
Name:BECHARA, SIMON B (MD)
Entity type:Individual
Prefix:MR
First Name:SIMON
Middle Name:B
Last Name:BECHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N. E GLEN OAK AVE.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637
Mailing Address - Country:US
Mailing Address - Phone:309-655-2730
Mailing Address - Fax:309-655-3297
Practice Address - Street 1:530 N. E GLEN OAK AVE.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637
Practice Address - Country:US
Practice Address - Phone:309-655-2730
Practice Address - Fax:309-655-3297
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2024-04-02
Deactivation Date:2024-01-29
Deactivation Code:
Reactivation Date:2024-04-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program