Provider Demographics
NPI:1174576078
Name:SIMONS, LAURA W (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:W
Last Name:SIMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1639
Mailing Address - Country:US
Mailing Address - Phone:606-877-9382
Mailing Address - Fax:909-877-9031
Practice Address - Street 1:1008 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1639
Practice Address - Country:US
Practice Address - Phone:606-877-9382
Practice Address - Fax:909-877-9031
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY316172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64316177Medicaid
KY0593601Medicare PIN
KYG60916Medicare UPIN
KY64316177Medicaid