Provider Demographics
NPI:1003872193
Name:SIMON, IRWIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:B
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2721
Mailing Address - Country:US
Mailing Address - Phone:702-735-2305
Mailing Address - Fax:702-538-9540
Practice Address - Street 1:2450 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2721
Practice Address - Country:US
Practice Address - Phone:702-735-2305
Practice Address - Fax:702-538-9540
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6762208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0002019607Medicaid
NV880104685OtherEIN
NV0002019607Medicaid