Provider Demographics
NPI:1891730917
Name:SIMON, TAMARA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:MARIE
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:951 E PLAZA DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7100
Mailing Address - Country:US
Mailing Address - Phone:208-939-3505
Mailing Address - Fax:208-939-3507
Practice Address - Street 1:951 E PLAZA DR
Practice Address - Street 2:SUITE 170
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6566
Practice Address - Country:US
Practice Address - Phone:208-939-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8909207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Not Answered207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDH39337Medicare UPIN