Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 30373 | SC |
N | 207RH0000X | Hematologist | ME83970 | FL |
N | 207RH0003X | Hematology & Oncology | 435665 | PA |
Y | 207RX0202X | Medical Oncology | ME83970 | FL |
NPI | 1164438768 |
---|---|
Provider Name | Dr. George Rajan Simon |
First Address | Celebration, FL 34747-4606 |
Second Address | Celebration, FL 34747-4606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 18/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1022465770001 | (05) | PA |
259450100 | (05) | FL |
35803 | BLUE CROSS BLUE SHIELD (01) | FL |
G65251 | (02) | FL |