Healthcare Provider Details

I. General information

NPI: 1356766554
Provider Name (Legal Business Name): JOSHUA ADRIAN SIMON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

IV. Provider business mailing address

4801 LINTON BLVD STE 10A
DELRAY BEACH FL
33445-6501
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7500
  • Fax:
Mailing address:
  • Phone: 561-708-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS14617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: