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General NPI Number Information
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NPI Number | 1003001488
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Entity Type | Organization
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Legal Business Name | FRED L SIMON MD PA
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 01/21/2008
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Provider Practice Location Address
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Address Line | 4665 S CONGRESS AVE SUITE 102
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City | LAKE WORTH
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State | FL
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Zip | 33461-4754
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Country | US
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Telephone | 561-649-0243
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Fax | 561-649-4132
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Provider Business Mailing Address
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Address Line | PO BOX 20689
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City | WEST PALM BEACH
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State | FL
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Zip | 33416-0689
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Country | US
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Telephone | 561-642-0243
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Fax | 561-649-4132
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRED L SIMON
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Credential | MD, FRCS(C) FACS
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Telephone | 561-642-0243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME30854
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License Number State | FL
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