Basic Information
| Provider Information | |||||||||
| NPI: | 1437275096 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMONS | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | ALINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14275 MIDWAY RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750013614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392751164 | ||||||||
| FaxNumber: | 6102714245 | ||||||||
| Practice Location | |||||||||
| Address1: | 1620 MEDICAL LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392751164 | ||||||||
| FaxNumber: | 2392755212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZF0201X | ME110034 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | 207ZP0101X | ME110034 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0102X | ML20009079 | WA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.