Provider Demographics
NPI:1205891512
Name:SIMON, DANIEL J (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4102 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2122
Mailing Address - Country:US
Mailing Address - Phone:919-595-2000
Mailing Address - Fax:919-595-2190
Practice Address - Street 1:4102 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2122
Practice Address - Country:US
Practice Address - Phone:919-595-2000
Practice Address - Fax:919-595-2190
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCTL28671207W00000X
NC2006-00474207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2006-00474OtherNC MEDICAL LICENSE
SCTL28671OtherSC MEDICAL LICENSE
SCTL28671OtherSC MEDICAL LICENSE