Healthcare Provider Details

I. General information

NPI: 1023050929
Provider Name (Legal Business Name): CYRIL M SIMON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MAIN AVE
LOVINGTON NM
88260-2830
US

IV. Provider business mailing address

1600 N MAIN AVE
LOVINGTON NM
88260-2830
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax: 575-396-1454
Mailing address:
  • Phone: 575-396-6611
  • Fax: 575-396-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08021000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2015-0518
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: