Provider Demographics
NPI:1508950130
Name:SIMON, MATTHIAS (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MATTHIAS
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16620 N US HIGHWAY 281 STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2679
Mailing Address - Country:US
Mailing Address - Phone:210-614-1231
Mailing Address - Fax:210-499-0811
Practice Address - Street 1:11481 TOEPPERWEIN RD STE 1202
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3146
Practice Address - Country:US
Practice Address - Phone:210-655-8470
Practice Address - Fax:210-967-0276
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061565A207R00000X
TXM5509207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00414UOtherGROUP PTAN
TX8J4606Medicare PIN
I73529Medicare UPIN