Healthcare Provider Details

I. General information

NPI: 1831101070
Provider Name (Legal Business Name): CRAIG A. SIMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 JAMES CASEY ST SUITE 3C
AUSTIN TX
78745-1120
US

IV. Provider business mailing address

PO BOX 42680
AUSTIN TX
78704-0043
US

V. Phone/Fax

Practice location:
  • Phone: 512-326-2800
  • Fax: 512-441-6388
Mailing address:
  • Phone: 512-326-2800
  • Fax: 512-441-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberK1060
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: