Healthcare Provider Details

I. General information

NPI: 1548205578
Provider Name (Legal Business Name): JAMES R SIMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 JOHNSON ST
JENNINGS LA
70546-3627
US

IV. Provider business mailing address

1907 JOHNSON ST
JENNINGS LA
70546-3627
US

V. Phone/Fax

Practice location:
  • Phone: 337-824-1000
  • Fax: 337-785-4734
Mailing address:
  • Phone: 337-230-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number011765
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number011765
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: