Provider Demographics
NPI:1467692798
Name:SIMONICH, JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:SIMONICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:18400 KATY FWY
Mailing Address - Street 2:STE 530
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1376
Mailing Address - Country:US
Mailing Address - Phone:281-717-4003
Mailing Address - Fax:281-206-7597
Practice Address - Street 1:915 GESSNER RD
Practice Address - Street 2:STE 225
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2527
Practice Address - Country:US
Practice Address - Phone:713-467-5787
Practice Address - Fax:713-467-0965
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201750101Medicaid
TX8L9906Medicare PIN