Provider Demographics
NPI:1831597228
Name:SIMON, ANTHONY DANE (MS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DANE
Last Name:SIMON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 WHITESAND COURT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148
Mailing Address - Country:US
Mailing Address - Phone:408-406-9772
Mailing Address - Fax:
Practice Address - Street 1:2 KORET WAY
Practice Address - Street 2:#N-319X UCSF BOX 0602
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143
Practice Address - Country:US
Practice Address - Phone:415-476-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001584363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care