Provider Demographics
NPI:1639353758
Name:ROBERT B SIMON MD
Entity Type:Organization
Organization Name:ROBERT B SIMON MD
Other - Org Name:ROBERT B SIMON MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-421-8020
Mailing Address - Street 1:4300 HARLAN STREET
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5122
Mailing Address - Country:US
Mailing Address - Phone:303-421-8020
Mailing Address - Fax:303-424-5927
Practice Address - Street 1:4300 HARLAN STREET
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5122
Practice Address - Country:US
Practice Address - Phone:303-421-8020
Practice Address - Fax:303-424-5927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCF1508Medicare PIN