Provider Demographics
NPI:1700222908
Name:SIMON, JASON BLAIR
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:BLAIR
Last Name:SIMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 HIGHWAY 365
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-7835
Mailing Address - Country:US
Mailing Address - Phone:409-722-9421
Mailing Address - Fax:409-722-6811
Practice Address - Street 1:3620 HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7835
Practice Address - Country:US
Practice Address - Phone:409-722-9421
Practice Address - Fax:409-722-6811
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50677237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00078SMedicare UPIN