MEDICARE: DR. PHILLIP ALEXANDER SIMON D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	15493	FL

General Provider Information

NPI Number	:	1265590129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP ALEXANDER SIMON D.M.D.

Provider Business Mailing Address
First Line	:	1913 CAPITAL CIR NE
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4421
Country	:	US
Telephone Number	:	850-878-5131
Fax Number	:	850-878-3521

Provider Business Practice Location Address
First Line	:	1348 TIMBERLANE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1766
Country	:	US
Telephone Number	:	850-878-5131
Fax Number	:	850-878-3521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	10/24/2019

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