Healthcare Provider Details

I. General information

NPI: 1871562405
Provider Name (Legal Business Name): ELIZABETH SIMONEAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 W FRANKLIN ST
TUCSON AZ
85701-8207
US

IV. Provider business mailing address

6255 N CAMPO ABIERTO #2
TUCSON AZ
85718-3452
US

V. Phone/Fax

Practice location:
  • Phone: 520-884-5249
  • Fax: 520-547-3395
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberAZ23693
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: