Healthcare Provider Details

I. General information

NPI: 1104831817
Provider Name (Legal Business Name): REBECCA C SIMONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24920 104TH AVE SE
KENT WA
98030-6443
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98057-4934
US

V. Phone/Fax

Practice location:
  • Phone: 253-395-2000
  • Fax:
Mailing address:
  • Phone: 425-656-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00039052
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: