Provider Demographics
NPI:1346318607
Name:UWAN, SIMONE (MD)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:
Last Name:UWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 E STATE ROAD 434 UNIT 1071
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5283
Mailing Address - Country:US
Mailing Address - Phone:407-767-8500
Mailing Address - Fax:407-767-6999
Practice Address - Street 1:587 E STATE ROAD 434 UNIT 1071
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5283
Practice Address - Country:US
Practice Address - Phone:407-767-8500
Practice Address - Fax:407-767-6999
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86386207Q00000X
FLME107669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEV013ZMedicare PIN