Provider Demographics
NPI:1396709168
Name:SIMONO, JANE E (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:SIMONO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:EMERY
Other - Last Name:SIMONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2440 E TUDOR RD
Mailing Address - Street 2:PMB 1168
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1185
Mailing Address - Country:US
Mailing Address - Phone:907-646-2559
Mailing Address - Fax:907-562-1319
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:STE. 322
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5222
Practice Address - Country:US
Practice Address - Phone:907-562-1234
Practice Address - Fax:907-561-8550
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK3959OtherLICENSE
AKMD0423Medicaid
BP4749151OtherDEA
G11188Medicare UPIN
AKK151017Medicare ID - Type Unspecified