Provider Demographics
NPI:1780408054
Name:SIMEON, SOREN S
Entity type:Individual
Prefix:
First Name:SOREN
Middle Name:S
Last Name:SIMEON
Suffix:
Gender:U
Credentials:
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 3427
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-3427
Mailing Address - Country:US
Mailing Address - Phone:907-543-6319
Mailing Address - Fax:907-543-6117
Practice Address - Street 1:700 CHIEF EDDIE HOFFMAN HWY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-3427
Practice Address - Country:US
Practice Address - Phone:907-543-6319
Practice Address - Fax:907-543-6117
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15-127-EFDHA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other