Provider Demographics
NPI:1407134372
Name:SIMON, RONALD D JR
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:SIMON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12506 DRAKE PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3892
Mailing Address - Country:US
Mailing Address - Phone:281-451-8904
Mailing Address - Fax:
Practice Address - Street 1:12506 DRAKE PRAIRIE LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3892
Practice Address - Country:US
Practice Address - Phone:281-451-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14511734343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)