Provider Demographics
NPI:1609053651
Name:SIMON, MYRON (DPM)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 W CHANTICLEER RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-2112
Mailing Address - Country:US
Mailing Address - Phone:714-776-8487
Mailing Address - Fax:714-776-0313
Practice Address - Street 1:1603 W CHANTICLEER RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2112
Practice Address - Country:US
Practice Address - Phone:714-776-8487
Practice Address - Fax:714-776-0313
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEFE940213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist