Provider Demographics
NPI:1730168477
Name:SIMON, BARRY KIRK (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:KIRK
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 PGA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2911
Mailing Address - Country:US
Mailing Address - Phone:561-275-7604
Mailing Address - Fax:561-802-5385
Practice Address - Street 1:2979 PGA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2911
Practice Address - Country:US
Practice Address - Phone:561-275-7670
Practice Address - Fax:561-802-5330
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME319192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00621517OtherRAILROAD MEDICARE
FL069350200Medicaid
FLD64601Medicare UPIN
FLP00621517OtherRAILROAD MEDICARE