Provider Demographics
NPI:1841276433
Name:SIMON, ESAN ODELL (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:ESAN
Middle Name:ODELL
Last Name:SIMON
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Gender:M
Credentials:MD, MBA
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Mailing Address - Street 1:15100 RESCUE WAY
Mailing Address - Street 2:USCG AIR STATION CLEARWATER MEDICAL CLINIC
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3502
Mailing Address - Country:US
Mailing Address - Phone:727-535-1437
Mailing Address - Fax:727-535-4190
Practice Address - Street 1:15100 RESCUE WAY
Practice Address - Street 2:USCG AIR STATION CLEARWATER MEDICAL CLINIC
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3502
Practice Address - Country:US
Practice Address - Phone:727-535-1437
Practice Address - Fax:727-535-4190
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2013-07-22
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Provider Licenses
StateLicense IDTaxonomies
VA0101102764207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine