Basic Information
| Provider Information | |||||||||
| NPI: | 1942810726 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTT DAVID SIMON MD FACS MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9834 GENESEE AVE STE 416 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583076585 | ||||||||
| FaxNumber: | 8583096593 | ||||||||
| Practice Location | |||||||||
| Address1: | 9834 GENESEE AVE STE 416 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583076585 | ||||||||
| FaxNumber: | 8583096593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2020 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIMON | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8583076585 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.