Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | OS 11689 | FL |
NPI | 1235327495 |
---|---|
Provider Name | Dr. Andrew Robert Simonsen |
First Address | St Petersburg, FL 33701-1547 |
Second Address | St Petersburg, FL 33701-1547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 24/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006311700 | (05) | FL |
14LY7 | BLUE CROSS (01) | FL |