Provider Demographics
NPI:1891966750
Name:SIMON, MARTIN (CRNFA)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-6453
Mailing Address - Country:US
Mailing Address - Phone:214-914-5089
Mailing Address - Fax:
Practice Address - Street 1:3111 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-6453
Practice Address - Country:US
Practice Address - Phone:214-914-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521377163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018HTOtherBLUE CROSS