Provider Demographics
NPI:1326144833
Name:SIMOVITZ, RICK (MD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:SIMOVITZ
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 1:722 THE RIALTO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3524
Mailing Address - Country:US
Mailing Address - Phone:941-484-8792
Mailing Address - Fax:
Practice Address - Street 1:722 THE RIALTO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3524
Practice Address - Country:US
Practice Address - Phone:941-484-8792
Practice Address - Fax:941-488-3981
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30576OtherBLUE SHIELD
FL30576Medicare ID - Type Unspecified
FL30576OtherBLUE SHIELD