=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205900511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOAH B. SIMONS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 03/31/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3641 SACRAMENTO ST SUITE A
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94118-1722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-601-1339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3641 SACRAMENTO ST SUITE A
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94118-1722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-601-1339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A91731
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------