Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | Y6809332 | CA |
NPI | 1336740216 |
---|---|
Provider Name | Thomas Robert Matthew Simpson |
First Address | Red Bluff, CA 96080-4905 |
Second Address | Red Bluff, CA 96080-4905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2020 |
Last Update Date | 05/11/2020 |