MEDICARE: LAURA LEE SIMON 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	208D00000X	General Practice Physician	DR41290	CO

General Provider Information

NPI Number	:	1346539954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LEE SIMON M.D.

Provider Business Mailing Address
First Line	:	6254 OXFORD PEAK CT
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-9467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6254 OXFORD PEAK CT
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-9467
Country	:	US
Telephone Number	:	303-345-3466
Fax Number	:

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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