Provider Demographics
NPI:1134340276
Name:SIMON, REBECCA LYNN (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6228 DENNING RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4069
Mailing Address - Country:US
Mailing Address - Phone:870-688-7600
Mailing Address - Fax:
Practice Address - Street 1:3864 HIGHWAY 392 W
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-9683
Practice Address - Country:US
Practice Address - Phone:870-204-5645
Practice Address - Fax:855-701-1410
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0432761207Q00000X
ARE-5961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179511001Medicaid
AR5H823Medicare PIN