Provider Demographics
NPI:1336147065
Name:SIMON, FRANK GOTHAM (MD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:GOTHAM
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6418
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0418
Mailing Address - Country:US
Mailing Address - Phone:502-895-5088
Mailing Address - Fax:502-897-2426
Practice Address - Street 1:1404 BROWNS LN
Practice Address - Street 2:SUITE B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4655
Practice Address - Country:US
Practice Address - Phone:502-895-5088
Practice Address - Fax:502-897-2426
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY14589207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64145899Medicaid
KY5483Medicare PIN
KYC69841Medicare UPIN