Provider Demographics
NPI:1447835087
Name:SIMON, MARC (NATUROPATHIC DOCTOR)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:NATUROPATHIC DOCTOR
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:631 JASON ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2357
Mailing Address - Country:US
Mailing Address - Phone:971-273-0084
Mailing Address - Fax:971-925-5223
Practice Address - Street 1:631 JASON ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2357
Practice Address - Country:US
Practice Address - Phone:971-273-0084
Practice Address - Fax:971-925-5223
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0134152175F00000X
CT5.000684175F00000X
WANT61356757175F00000X
OR4487175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1700040052Medicaid
OR923934093OtherIRS