MEDICARE: RYAN FRED SIMONS PA-C

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	363A00000X	Physician Assistant
2	363AS0400X	Surgical Physician Assistant	PA1272	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	FF014Z	OTHER	NV	MEDICARE PTAN

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

General Provider Information

NPI Number	:	1902111792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN FRED SIMONS PA-C

Provider Business Mailing Address
First Line	:	3012 S DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9186
Country	:	US
Telephone Number	:	702-835-0088
Fax Number	:	702-826-3162

Provider Business Practice Location Address
First Line	:	3012 S DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9186
Country	:	US
Telephone Number	:	702-835-0088
Fax Number	:	702-826-3162

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

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	11/19/2020

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Directions to “ RYAN FRED SIMONS PA-C” Practice Location

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