Provider Demographics
NPI:1033186184
Name:SIMON, EMESE (MD, FAAPMR, DIPABLM)
Entity type:Individual
Prefix:DR
First Name:EMESE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD, FAAPMR, DIPABLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3509
Practice Address - Country:US
Practice Address - Phone:941-917-5200
Practice Address - Fax:941-917-5201
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC89590208100000X
MEMD21040208100000X, 2081P2900X, 2081P2900X, 2083P0901X
FLME93615208100000X, 2081S0010X, 2083P0901X
FLME836152083S0010X
MEME836152083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00311790OtherMEDICARE RR
FL203858426OtherTAX ID
FL203858426OtherTAX ID
FL34091ZMedicare PIN