Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 81-316 | NM |
NPI | 1952392516 |
---|---|
Provider Name | Dr. J. Mitchell Simson |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106-2235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 11/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D35970 | (02) | NM |
P5388 | (05) | NM |