Provider Demographics
NPI:1386641470
Name:SIMONS, GLEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:W
Last Name:SIMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3080 HARRODSBURG RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2787
Mailing Address - Country:US
Mailing Address - Phone:859-455-8346
Mailing Address - Fax:859-455-8866
Practice Address - Street 1:3080 HARRODSBURG RD STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2787
Practice Address - Country:US
Practice Address - Phone:859-455-8346
Practice Address - Fax:859-455-8866
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36709208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64039829Medicaid
KY6593553800Medicaid
F25054Medicare UPIN