Provider Demographics
NPI:1033186184
Name:SIMON, EMESE (MD, FAAPMR, DIPABLM)
Entity Type:Individual
Prefix:DR
First Name:EMESE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD, FAAPMR, DIPABLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2859
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-2859
Mailing Address - Country:US
Mailing Address - Phone:888-279-0232
Mailing Address - Fax:866-804-6331
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4210
Practice Address - Country:US
Practice Address - Phone:864-797-7100
Practice Address - Fax:864-797-7105
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD210402081P2900X, 208100000X, 2081P2900X, 2083P0901X
SC89590208100000X
FLME83615208100000X, 2083S0010X
FLME936152081S0010X, 2083P0901X
MEME836152083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00311790OtherMEDICARE RR
FL203858426OtherTAX ID
FL203858426OtherTAX ID
FL34091ZMedicare PIN