Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 30.022834 | OH |
Y | 1223E0200X | Endodontist | D 8060 | AZ |
NPI | 1134437312 |
---|---|
Provider Name | Michael G Simpson |
First Address | Sun City West, AZ 85375-4438 |
Second Address | Sun City West, AZ 85375-4438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2010 |
Last Update Date | 21/09/2010 |