Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MEDS8005 | AK |
N | 2081P2900X | Pain Medicine | 4424 | SD |
N | 2081P2900X | Pain Medicine | 6326A | WY |
N | 2081P2900X | Pain Medicine | C51604 | CA |
NPI | 1194827998 |
---|---|
Provider Name | Mark John Simonson |
First Address | Soldotna, AK 99669-2509 |
Second Address | Ventura, CA 93003-6151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 04/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G21682 | (02) |