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General NPI Number Information
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NPI Number | 1770764250
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Entity Type | Organization
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Legal Business Name | SIMON ISAAC M D P A
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 448 S MILWEE ST
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City | LONGWOOD
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State | FL
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Zip | 32750-4163
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Country | US
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Telephone | 407-767-2996
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Fax | 407-767-0296
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Provider Business Mailing Address
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Address Line | PO BOX 915259
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City | LONGWOOD
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State | FL
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Zip | 32791-5259
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Country | US
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Telephone | 407-767-2996
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Fax | 407-767-0296
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIMON B ISAAC
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Credential | M.D.
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Telephone | 407-968-5218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME95429
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License Number State | FL
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