Healthcare Provider Details

I. General information

NPI: 1962404533
Provider Name (Legal Business Name): PAUL SIMON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E HALLANDALE BEACH BLVD #800
HALLANDALE BEACH FL
33009-4634
US

IV. Provider business mailing address

1250 E HALLANDALE BEACH BLVD #800
HALLANDALE BEACH FL
33009-4634
US

V. Phone/Fax

Practice location:
  • Phone: 954-456-5050
  • Fax: 954-456-5095
Mailing address:
  • Phone: 954-456-5050
  • Fax: 954-456-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME29327
License Number StateFL

VIII. Authorized Official

Name: DR. PAUL EDWIN SIMON
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 954-456-5050