Individual
MR. PETER SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CST
Contact information
Practice address
3505 SW SOUNDVIEW DR, DUNNELLON, FL 34431-3172
(561) 797-7169
Mailing address
3505 SW SOUNDVIEW DR, DUNNELLON, FL 34431-3172
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S550-660-69-422-0
DRIVER LICENSE
FL
Enumeration date
06/24/2020
Last updated
06/24/2020
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