Provider Demographics
NPI:1023067436
Name:SIMON, STEVEN A (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63069
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-3069
Mailing Address - Country:US
Mailing Address - Phone:305-662-2554
Mailing Address - Fax:305-662-4441
Practice Address - Street 1:7500 SW 87TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5426
Practice Address - Country:US
Practice Address - Phone:305-662-2554
Practice Address - Fax:305-662-4441
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037772207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02520OtherBLUE CROSS BLUE SHIELD
FL260136201Medicaid
FLD50546Medicare UPIN
02520AMedicare PIN