Provider Demographics
NPI:1083926877
Name:SHEARD, SIMON (DO)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:SHEARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 S KYRENE RD STE D-103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2120
Mailing Address - Country:US
Mailing Address - Phone:480-269-3208
Mailing Address - Fax:480-674-1295
Practice Address - Street 1:8380 S KYRENE RD # D-103
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2120
Practice Address - Country:US
Practice Address - Phone:480-269-3208
Practice Address - Fax:480-674-1295
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR1815OtherTRAINING PERMIT