Healthcare Provider Details

I. General information

NPI: 1194827998
Provider Name (Legal Business Name): MARK JOHN SIMONSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL PL STE 204B
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

PO BOX 2509
SOLDOTNA AK
99669-2509
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4120
  • Fax:
Mailing address:
  • Phone: 907-260-5455
  • Fax: 907-714-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number4424
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number6326A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberC51604
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMEDS8005
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number6326A
License Number StateWY
# 6
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4424
License Number StateSD
# 7
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC51604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: