Provider Demographics
NPI:1154585016
Name:DAVID R SIMON MD PHD PA
Entity type:Organization
Organization Name:DAVID R SIMON MD PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:954-472-2007
Mailing Address - Street 1:201 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2039
Mailing Address - Country:US
Mailing Address - Phone:954-472-2007
Mailing Address - Fax:954-472-2114
Practice Address - Street 1:201 N UNIVERSITY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2039
Practice Address - Country:US
Practice Address - Phone:954-472-2007
Practice Address - Fax:954-472-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024567207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL406183465OtherRAILROAD MEDICARE
FLAK982OtherBLUE CROSS BLUE SHIELD
FL406183465OtherRAILROAD MEDICARE
FLAK982Medicare PIN