Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME7728 | FL |
N | 207ND0900X | Dermatopathologist | ME7728 | FL |
NPI | 1053483420 |
---|---|
Provider Name | Louis Simonson |
First Address | Hollywood, FL 33020-6828 |
Second Address | Hollywood, FL 33020-6828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 11/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D51547 | (02) |