Provider Demographics
NPI:1255374609
Name:SIMON, JOHN ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERNEST
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:701 25TH AVE S
Mailing Address - Street 2:#303
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1513
Mailing Address - Country:US
Mailing Address - Phone:612-333-9954
Mailing Address - Fax:612-333-9969
Practice Address - Street 1:701 25TH AVE S
Practice Address - Street 2:#303
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1513
Practice Address - Country:US
Practice Address - Phone:612-333-9954
Practice Address - Fax:612-333-9969
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN237812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA93750Medicare UPIN