Provider Demographics
NPI:1972929644
Name:SIMON, CARL DALE SR
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:DALE
Last Name:SIMON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22722 SAGINAW POINT LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5158
Mailing Address - Country:US
Mailing Address - Phone:713-894-0757
Mailing Address - Fax:
Practice Address - Street 1:22722 SAGINAW POINT LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5158
Practice Address - Country:US
Practice Address - Phone:713-894-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide