Provider Demographics
NPI:1740315993
Name:SIMON, CRAIG PHILLIP (PA-C)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:PHILLIP
Last Name:SIMON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2839
Mailing Address - Country:US
Mailing Address - Phone:252-514-4770
Mailing Address - Fax:252-514-4773
Practice Address - Street 1:2842 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2839
Practice Address - Country:US
Practice Address - Phone:252-514-4770
Practice Address - Fax:252-514-4773
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant