Provider Demographics
NPI:1235327495
Name:SIMONSEN, ANDREW ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ROBERT
Last Name:SIMONSEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1033 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1547
Mailing Address - Country:US
Mailing Address - Phone:727-456-3288
Mailing Address - Fax:727-456-3289
Practice Address - Street 1:1033 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:SUITE 108
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1547
Practice Address - Country:US
Practice Address - Phone:727-456-3288
Practice Address - Fax:727-456-3289
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2014-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 11689207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14LY7OtherBLUE CROSS
FL006311700Medicaid
FL006311700Medicaid