Provider Demographics
NPI:1366467946
Name:SIMON, DAVID R (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Mailing Address - Street 1:201 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2039
Mailing Address - Country:US
Mailing Address - Phone:954-472-2007
Mailing Address - Fax:954-472-2114
Practice Address - Street 1:201 N UNIVERSITY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2039
Practice Address - Country:US
Practice Address - Phone:954-472-2007
Practice Address - Fax:954-472-2114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0024567207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL406183465OtherRAILROAD MEDICARE
FL92834OtherBCBS PIN
FL592055534OtherEMPLOYER ID NUMBER
92834YMedicare PIN
FL92834OtherBCBS PIN