Provider Demographics
NPI:1346290871
Name:SIMON, STEVEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
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 1:7101 NE 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-4933
Mailing Address - Country:US
Mailing Address - Phone:360-944-4802
Mailing Address - Fax:
Practice Address - Street 1:400 HICKORY ST NW
Practice Address - Street 2:SUITE 303
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1700
Practice Address - Country:US
Practice Address - Phone:541-812-5275
Practice Address - Fax:541-812-5276
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0067366207Q00000X
ORMD21230207R00000X
WAMD60652458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150975Medicaid
A51904Medicare UPIN
OR150975Medicaid
OR080123663Medicare PIN