Provider Demographics
NPI:1083020556
Name:SIMOROV, ANTON (MD)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:SIMOROV
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 1:4728 CASS ST APT 15
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3041
Mailing Address - Country:US
Mailing Address - Phone:402-201-6952
Mailing Address - Fax:
Practice Address - Street 1:2701 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4407
Practice Address - Country:US
Practice Address - Phone:402-844-8325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-06
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31755208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery