Healthcare Provider Details

I. General information

NPI: 1033150271
Provider Name (Legal Business Name): MARK N SIMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 ROSLYN ST
DENVER CO
80238-2624
US

IV. Provider business mailing address

DEPT 557
DENVER CO
80291-0557
US

V. Phone/Fax

Practice location:
  • Phone: 303-403-6333
  • Fax: 303-403-6325
Mailing address:
  • Phone: 303-467-4155
  • Fax: 303-467-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number39050
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: