Provider Demographics
NPI:1053359919
Name:SIMON-MARK, ROBIN GAYLE (DO)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:GAYLE
Last Name:SIMON-MARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:G
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2607 POLK ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4822
Mailing Address - Country:US
Mailing Address - Phone:954-925-7333
Mailing Address - Fax:954-925-7339
Practice Address - Street 1:2607 POLK ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020
Practice Address - Country:US
Practice Address - Phone:954-925-7333
Practice Address - Fax:954-925-7339
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7659207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256295200Medicaid
FLEOB10WMedicare UPIN