=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174576078
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA W SIMONS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 05/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1008 SHERWOOD DR
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-877-9382
-----------------------------------------------------
Fax | 909-877-9031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1008 SHERWOOD DR
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-877-9382
-----------------------------------------------------
Fax | 909-877-9031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 31617
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------