Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 20A15185 | CA |
N | 2084N0400X | Neurologist | DO192558 | OR |
NPI | 1013301340 |
---|---|
Provider Name | Dr. Tyrell Jonathan Simkins |
First Address | Sacramento, CA 95816-5266 |
Second Address | Sacramento, CA 95816-5266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2015 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A15185 | CALIFORNIA MEDICAL LICENSE (01) | CA |
DO192558 | OREGON MEDICAL LICENSE (01) | OR |