Provider Demographics
NPI:1093784696
Name:SIMEON, SCOTT BRANDON (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:BRANDON
Last Name:SIMEON
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 1:200 W ESPLANADE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2489
Mailing Address - Country:US
Mailing Address - Phone:504-712-7000
Mailing Address - Fax:504-712-7040
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-712-7000
Practice Address - Fax:504-712-7040
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023871207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1485845Medicaid
LA1485845Medicaid
LAH07731Medicare UPIN