Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD070363L | PA |
Y | 111NI0900X | Internist | MD070363L | PA |
N | 207RA0401X | Internist - Addiction Medicine | MD070363L | PA |
NPI | 1700873312 |
---|---|
Provider Name | Dr. Paul Kerry Simpson |
First Address | Williamsport, PA 17701 |
Second Address | Williamsport, PA 17701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 13/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017946810002 | (05) | PA |
E86194 | (02) |