Provider Information for 1174070692
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JOSHUA SIMON
Sex: Male
NPI: 1174070692
Last Updated: 2016-09-01
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1174070692 | ||||||||
| Enumeration Date | 2016-09-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 200 SCOTIA DR APT 103 HYPOLUXO, FL 33462 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 200 SCOTIA DR APT 103 HYPOLUXO, FL 33462-6096 United States Phone: 561-313-5735 | Fax: | ||||||||
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