Provider Demographics
NPI:1700830171
Name:SIMON, FAY E (MD)
Entity Type:Individual
Prefix:DR
First Name:FAY
Middle Name:E
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 1:1441 N BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1201
Mailing Address - Country:US
Mailing Address - Phone:214-947-2455
Mailing Address - Fax:214-947-2390
Practice Address - Street 1:1441 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-947-2455
Practice Address - Fax:214-947-2390
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179743302Medicaid
TX179743301Medicaid
TX8A0788OtherBCBS
TX179743302Medicaid
TX8A0788OtherBCBS
TXI49947Medicare UPIN
TX179743301Medicaid