Provider Demographics
NPI:1942810726
Name:SCOTT DAVID SIMON MD FACS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SCOTT DAVID SIMON MD FACS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-307-6585
Mailing Address - Street 1:9834 GENESEE AVE STE 416
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1264
Mailing Address - Country:US
Mailing Address - Phone:858-307-6585
Mailing Address - Fax:858-309-6593
Practice Address - Street 1:9834 GENESEE AVE STE 416
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1264
Practice Address - Country:US
Practice Address - Phone:858-307-6585
Practice Address - Fax:858-309-6593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty