Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 12207 | FL |
NPI | 1215090675 |
---|---|
Provider Name | Michael A. Simon |
First Address | Hallandale Beach, FL 33009-4834 |
Second Address | Hallandale Beach, FL 33009-4834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U41750 | (02) | FL |