Provider Demographics
NPI:1558441162
Name:PETER W. SIMONEAUX, MD, APMC
Entity type:Organization
Organization Name:PETER W. SIMONEAUX, MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIMONEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-845-1674
Mailing Address - Street 1:1011 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3631
Mailing Address - Country:US
Mailing Address - Phone:985-845-1674
Mailing Address - Fax:501-421-6274
Practice Address - Street 1:1011 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3631
Practice Address - Country:US
Practice Address - Phone:985-845-1674
Practice Address - Fax:501-421-6274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018423207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CC41Medicare PIN
LA5CW94Medicare PIN