Healthcare Provider Details

I. General information

NPI: 1124091921
Provider Name (Legal Business Name): JOHN K SIMONSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 10/02/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 N 22ND ST
BLAIR NE
68008
US

IV. Provider business mailing address

812 N 22ND ST
BLAIR NE
68008-1128
US

V. Phone/Fax

Practice location:
  • Phone: 402-426-4611
  • Fax: 402-426-4642
Mailing address:
  • Phone: 402-426-4611
  • Fax: 402-426-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19620
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: