Provider Demographics
NPI:1194824714
Name:SIMON, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SIMON
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 1:600 S. PINE ISLAND ROAD
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-473-6344
Mailing Address - Fax:954-473-8119
Practice Address - Street 1:600 S. PINE ISLAND ROAD
Practice Address - Street 2:SUITE # 300
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-473-6344
Practice Address - Fax:954-473-8119
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60163174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE62244Medicare UPIN