Individual
DR. LLEWELLYN SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
320 N HOOD ST, LAKE PROVIDENCE, LA 71254-2140
(318) 559-2404
(318) 559-2430
Mailing address
320 N HOOD ST, LAKE PROVIDENCE, LA 71254-2140
(318) 559-2404
(318) 559-2430
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11828R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11828R
STATE LICENSE
LA
05
—
1680893
—
LA
Enumeration date
11/15/2005
Last updated
10/16/2019
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