Provider Demographics
NPI:1629080106
Name:SIMON, DYAN MEREDITH (MD)
Entity Type:Individual
Prefix:
First Name:DYAN
Middle Name:MEREDITH
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9012 SE 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5019
Mailing Address - Country:US
Mailing Address - Phone:206-526-2600
Mailing Address - Fax:206-526-0219
Practice Address - Street 1:3626 NE 45TH ST
Practice Address - Street 2:300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5652
Practice Address - Country:US
Practice Address - Phone:206-526-0581
Practice Address - Fax:206-526-0219
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000378652080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine