Individual
EDWARD SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25989 BARBER CUT OFF RD NE, SUITE A3, KINGSTON, WA 98346-8455
(360) 297-4911
(360) 297-7047
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5686
NV
207R00000X
Internal Medicine Physician
Primary
MD60604626
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002016158
—
NV
01
—
11041825
CAQH
—
Enumeration date
01/09/2006
Last updated
03/24/2016
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