Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD008430E | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD008430E | PA |
NPI | 1043283096 |
---|---|
Provider Name | Ronald William Simonsen |
First Address | Warren, PA 16365 |
Second Address | Warren, PA 16365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C27293 | (02) |