Provider Demographics
NPI:1437145919
Name:SIMON, FRED L (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:L
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:PO BOX 20689
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33416-0689
Mailing Address - Country:US
Mailing Address - Phone:561-649-0243
Mailing Address - Fax:561-649-0243
Practice Address - Street 1:4665 S CONGRESS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4754
Practice Address - Country:US
Practice Address - Phone:561-649-0243
Practice Address - Fax:561-649-4132
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 30854208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038426700Medicaid
FL000594200Medicaid
FLP00686507OtherRAILROAD MEDICARE
FLP00686507OtherRAILROAD MEDICARE
E31873Medicare UPIN
FL000594200Medicaid