Provider Demographics
NPI:1740690056
Name:SIMON, ERICA MARIE (DO)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:SIMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MARIE
Other - Last Name:BRUEGGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:SAN ANTONIO MILITARY MEDICAL CENTER MCHE EMR
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-6129
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:SAN ANTONIO MILITARY MEDICAL CENTER MCHE EMR
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204487207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty