Healthcare Provider Details

I. General information

NPI: 1760489892
Provider Name (Legal Business Name): JOHN C SIMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 N HWY 190
COVINGTON LA
70433-5158
US

IV. Provider business mailing address

PO BOX 3370
COVINGTON LA
70434-3370
US

V. Phone/Fax

Practice location:
  • Phone: 985-867-8585
  • Fax: 985-867-3644
Mailing address:
  • Phone: 985-867-8585
  • Fax: 985-867-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD.021048
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD.021048
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.021048
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: