Provider Demographics
NPI:1194902049
Name:DAVID A SIMONSON DPM PA
Entity type:Organization
Organization Name:DAVID A SIMONSON DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-638-2121
Mailing Address - Street 1:1950 ROCKLEDGE BLVD
Mailing Address - Street 2:STE# 107
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3763
Mailing Address - Country:US
Mailing Address - Phone:321-638-2121
Mailing Address - Fax:321-638-2126
Practice Address - Street 1:1950 ROCKLEDGE BLVD
Practice Address - Street 2:STE# 107
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3763
Practice Address - Country:US
Practice Address - Phone:321-638-2121
Practice Address - Fax:321-638-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2762335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ451AMedicare PIN
FL4168490001Medicare NSC