Provider Demographics
NPI:1003001488
Name:FRED L SIMON MD PA
Entity Type:Organization
Organization Name:FRED L SIMON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FRCS(C) FACS
Authorized Official - Phone:561-642-0243
Mailing Address - Street 1:PO BOX 20689
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33416-0689
Mailing Address - Country:US
Mailing Address - Phone:561-642-0243
Mailing Address - Fax:561-649-4132
Practice Address - Street 1:4665 S CONGRESS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4754
Practice Address - Country:US
Practice Address - Phone:561-649-0243
Practice Address - Fax:561-649-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30854208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty