MEDICARE: DR. FRED L SIMON MD

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	208600000X	Surgery Physician	ME 30854	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00686507	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437145919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED L SIMON MD

Provider Business Mailing Address
First Line	:	PO BOX 20689
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33416-0689
Country	:	US
Telephone Number	:	561-649-0243
Fax Number	:	561-649-0243

Provider Business Practice Location Address
First Line	:	4665 S CONGRESS AVE
Second Line	:	SUITE 100
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4754
Country	:	US
Telephone Number	:	561-649-0243
Fax Number	:	561-649-4132

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	05/15/2009

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Directions to “ DR. FRED L SIMON MD” Practice Location

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