1952392516 NPI number — DR. J. MITCHELL SIMSON MD, MPH

Table of content: DR. J. MITCHELL SIMSON MD, MPH (NPI 1952392516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952392516 NPI number — DR. J. MITCHELL SIMSON MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMSON
Provider First Name:
J.
Provider Middle Name:
MITCHELL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMSON
Provider Other First Name:
J.
Provider Other Middle Name:
MITCHELL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1952392516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1933 BRADBURY DRIVE SE
Provider Second Line Business Mailing Address:
SUITE 2222
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87106-4374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-3120
Provider Business Mailing Address Fax Number:
505-272-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 LOMAS BLVD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106-2235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-3850
Provider Business Practice Location Address Fax Number:
505-272-8018
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RA0401X , with the licence number:  81-316 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P5388 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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