Healthcare Provider Details

I. General information

NPI: 1912161290
Provider Name (Legal Business Name): ROBERT LOUIS SIMON SA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N HICKORY AVE
COOKEVILLE TN
38501-2431
US

IV. Provider business mailing address

404 N HICKORY AVE
COOKEVILLE TN
38501-2431
US

V. Phone/Fax

Practice location:
  • Phone: 931-526-9518
  • Fax: 931-372-0087
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: