Provider Demographics
NPI:1780647594
Name:SIMON, SAAN S (DO)
Entity Type:Individual
Prefix:DR
First Name:SAAN
Middle Name:S
Last Name:SIMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-1200
Mailing Address - Country:US
Mailing Address - Phone:702-873-4567
Mailing Address - Fax:702-873-0414
Practice Address - Street 1:2320 PASEO DEL PRADO
Practice Address - Street 2:B-207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4358
Practice Address - Country:US
Practice Address - Phone:702-873-4567
Practice Address - Fax:702-873-0414
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5202207L00000X
NV1151207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124611805Medicaid
TX8G2982Medicare ID - Type Unspecified
NVV105889Medicare PIN
TX124611805Medicaid
NVG15353Medicare UPIN