Individual
SCOTT DAVID SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9834 GENESEE AVE, SUITE 416, LA JOLLA, CA 92037-1223
(858) 458-0099
(858) 429-7935
Mailing address
PO BOX 25100, FRESNO, CA 93729-5100
(559) 326-1222
(559) 326-1230
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
A89550
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB228657
MEDICARE PTAN
CA
01
—
GI563A
MEDICARE GROUP PTAN
CA
Enumeration date
05/31/2006
Last updated
01/27/2020
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