Provider Demographics
NPI:1942214333
Name:SIMON, RICHARD D JR (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:SIMON
Suffix:JR
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 1477
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0312
Mailing Address - Country:US
Mailing Address - Phone:509-522-5815
Mailing Address - Fax:509-522-5818
Practice Address - Street 1:401 W POPLAR
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-522-5946
Practice Address - Fax:509-522-5744
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018852207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8483406Medicaid
WA8483406Medicaid
A09416Medicare UPIN