Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 18878 | CO |
N | 2080A0000X | Adolescent Medicine | 18878 | CO |
NPI | 1205930302 |
---|---|
Provider Name | Dr. David C Simon |
First Address | Castle Rock, CO 80104-2662 |
Second Address | Castle Rock, CO 80104-2662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 21/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01188788 | (05) | CO |
04007407 | (05) | CO |