Provider Demographics
NPI:1629300306
Name:SIMON, DAVID (LAC, AP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:LAC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLUFF VIEW DR APT 603A
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1372
Mailing Address - Country:US
Mailing Address - Phone:727-430-2783
Mailing Address - Fax:
Practice Address - Street 1:100 BLUFF VIEW DR APT 603A
Practice Address - Street 2:
Practice Address - City:BELLEAIR BLUFFS
Practice Address - State:FL
Practice Address - Zip Code:33770-1372
Practice Address - Country:US
Practice Address - Phone:727-430-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2659171100000X
FLAP2659171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist