Provider Demographics
NPI:1174919534
Name:SIMPSON DERMCARE AND FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:SIMPSON DERMCARE AND FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAC
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-472-1992
Mailing Address - Street 1:3070 WIMBLEDON CIR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4565
Mailing Address - Country:US
Mailing Address - Phone:208-524-2222
Mailing Address - Fax:
Practice Address - Street 1:2225 TETON PLZ
Practice Address - Street 2:STE B
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6494
Practice Address - Country:US
Practice Address - Phone:208-524-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty