MEDICARE: DR. MARY F SIMON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	40323	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A403230	OTHER	CA	BLUE SHIELD PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194711275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY F SIMON M.D.

Provider Business Mailing Address
First Line	:	5715 N WEST AVE STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-2376
Country	:	US
Telephone Number	:	559-228-3069
Fax Number	:	559-228-9228

Provider Business Practice Location Address
First Line	:	5715 N WEST AVE STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-2376
Country	:	US
Telephone Number	:	559-228-3069
Fax Number	:	559-228-9228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	02/20/2015

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