MEDICARE: TODD SIMON DO

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	207RG0100X	Gastroenterology Physician	OS6993	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225073489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD SIMON DO

Provider Business Mailing Address
First Line	:	5401 S CONGRESS AVE STE 211
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6637
Country	:	US
Telephone Number	:	561-964-8221
Fax Number	:	561-964-7393

Provider Business Practice Location Address
First Line	:	5401 S CONGRESS AVE STE 211
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6637
Country	:	US
Telephone Number	:	561-964-8221
Fax Number	:	561-964-7393

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	01/14/2021

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Directions to “ TODD SIMON DO” Practice Location

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