Provider Demographics
NPI:1891757209
Name:SIMON, TROY D (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:D
Last Name:SIMON
Suffix:
Gender:M
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:800 SCOTT AND WHITE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6440
Practice Address - Country:US
Practice Address - Phone:979-207-4000
Practice Address - Fax:979-207-4562
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6727207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1514440-03OtherCSHCN
TX8F1193OtherBLUE SHIELD
TX1514440-01Medicaid
TX040017502OtherRR/MEDICARE
TX8F1193OtherBLUE SHIELD
TX8132B6Medicare ID - Type Unspecified