Provider Demographics
NPI:1518498526
Name:SIMON, RUSSELL PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:PHILLIP
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7593 W BOYNTON BEACH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6162
Mailing Address - Country:US
Mailing Address - Phone:561-678-2652
Mailing Address - Fax:888-316-2198
Practice Address - Street 1:5401 S CONGRESS AVE STE 102
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6636
Practice Address - Country:US
Practice Address - Phone:561-967-5033
Practice Address - Fax:561-967-5424
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2023-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME162673207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease