Healthcare Provider Details

I. General information

NPI: 1366490617
Provider Name (Legal Business Name): JEFFREY A SIMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 OLD HICKORY BLVD STE 1-260
BRENTWOOD TN
37027-4528
US

IV. Provider business mailing address

750 OLD HICKORY BLVD STE 1-260
BRENTWOOD TN
37027-4528
US

V. Phone/Fax

Practice location:
  • Phone: 615-376-7500
  • Fax:
Mailing address:
  • Phone: 615-376-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberM-10835
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD201699
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number44627
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME85283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: