Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | LP13 | OK |
NPI | 1477790111 |
---|---|
Provider Name | Chad Simpson |
First Address | Duncan, OK 73533-4191 |
Second Address | Duncan, OK 73533-4191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2009 |
Last Update Date | 13/02/2017 |