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General NPI Number Information
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NPI Number | 1073784534
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Entity Type | Organization
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Legal Business Name | JOCK SIMON
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 30686 SATTERFIELD CT
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City | SALISBURY
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State | MD
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Zip | 21804-2365
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Country | US
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Telephone | 410-742-3204
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Fax |
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Provider Business Mailing Address
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Address Line | 30686 SATTERFIELD CT
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City | SALISBURY
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State | MD
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Zip | 21804-2365
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Country | US
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Telephone | 410-742-3204
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOCK SIMON
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Credential | MD
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Telephone | 410-742-8204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0028257
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License Number State | MD
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