Provider Demographics
NPI:1801874896
Name:SIMONS, BRAD DAVID (MD PHD PA)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:DAVID
Last Name:SIMONS
Suffix:
Gender:M
Credentials:MD PHD PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2141 S HIGHWAY A1A ALT
Mailing Address - Street 2:STE 210 THREE PALMS CENTER
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4072
Mailing Address - Country:US
Mailing Address - Phone:561-747-4100
Mailing Address - Fax:561-747-8822
Practice Address - Street 1:2141 S HIGHWAY A1A ALT
Practice Address - Street 2:STE 210 THREE PALMS CENTER
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4072
Practice Address - Country:US
Practice Address - Phone:561-747-4100
Practice Address - Fax:561-747-8822
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME76183207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254313300Medicaid
FL254313300Medicaid
43867Medicare ID - Type Unspecified