Provider Demographics
NPI:1063470631
Name:SIMON, DAVID JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEFFREY
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 951806
Mailing Address - Street 2:ELLWOOD EMERGENCY PHYSICIANS INC
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0020
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-660-9384
Practice Address - Street 1:724 PERSHING STREET
Practice Address - Street 2:ELLWOOD CITY HOSPITAL
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117
Practice Address - Country:US
Practice Address - Phone:724-752-6744
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018008E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA142346Medicare ID - Type Unspecified
PAD71275Medicare UPIN