Provider Demographics
NPI:1770561805
Name:SIMONSON, DAVID ANDREW (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANDREW
Last Name:SIMONSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ROCKLEDGE BLVD
Mailing Address - Street 2:STE# 107
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3763
Mailing Address - Country:US
Mailing Address - Phone:321-638-2121
Mailing Address - Fax:321-638-2126
Practice Address - Street 1:1950 ROCKLEDGE BLVD
Practice Address - Street 2:STE# 107
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3763
Practice Address - Country:US
Practice Address - Phone:321-638-2121
Practice Address - Fax:321-638-2126
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02762213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340434000Medicaid
FLU79250Medicare UPIN
FL65646YMedicare PIN