Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS 668100 | FL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS6681 | FL |
NPI | 1215028378 |
---|---|
Provider Name | Dr. John Lawrence Simons JR. |
First Address | Jacksonville, FL 32257-2425 |
Second Address | Jacksonville, FL 32257-2425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 03/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F79136 | (02) | |
OS 668100 | MEDICAL LICENSE (01) | FL |