Provider Demographics
NPI:1932165958
Name:SIMONIE, FREDERICK S (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:S
Last Name:SIMONIE
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 1:10210 N 92ND ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4524
Mailing Address - Country:US
Mailing Address - Phone:480-314-1189
Mailing Address - Fax:
Practice Address - Street 1:10210 N 92ND ST STE 205
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4524
Practice Address - Country:US
Practice Address - Phone:480-314-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12188174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD37656Medicare UPIN
AZZ115030Medicare PIN