Simon, Mark O

Simon, Mark O is an individual health care provider with primary practice located at 1650 Cowles St , Fairbanks AK 99701-5925. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medical Services, which is considered as his primary health care specialty. Simon, Mark O can be contacted via phone (907) 458-5556.

Contact Information

Primary practice address
1650 Cowles St Fairbanks AK 99701-5925
Phone: (907) 458-5556
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 4813 Alaska

Profile Details

NPI number 1043207533
LBN Legal business name Simon, Mark O
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043207533 NPPES
Alaska MEDICAID MD2451

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