Healthcare Provider Details

I. General information

NPI: 1629068200
Provider Name (Legal Business Name): JEAN SIMARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 KATE BOND RD
BARTLETT TN
38133-4004
US

IV. Provider business mailing address

6077 PRIMACY PKWY STE 140
MEMPHIS TN
38119-5742
US

V. Phone/Fax

Practice location:
  • Phone: 901-381-4664
  • Fax: 901-373-3804
Mailing address:
  • Phone: 901-259-1673
  • Fax: 901-259-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number021397
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number021397
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: