Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | SL0580 | NV |
N | 111NI0900X | Internist | SL0580 | NV |
Y | 207X00000X | Orthopaedic Surgeon | DR0053689 | CO |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 34010234 | OH |
NPI | 1063668747 |
---|---|
Provider Name | Mr. Gary Alexander Simpson |
First Address | Colorado Springs, CO 80920-3487 |
Second Address | Colorado Springs, CO 80920-3487 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 25/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0083504 | (05) | OH |
66021774 | (05) | CO |