Basic Information
| Provider Information | |||||||||
| NPI: | 1205896073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | LARRY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 N COX ST | ||||||||
| Address2: | SUITE 27 | ||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272035514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366296500 | ||||||||
| FaxNumber: | 3366299500 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 N COX ST | ||||||||
| Address2: | SUITE 27 | ||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272035514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366296500 | ||||||||
| FaxNumber: | 3366299500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 18715 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8976390 | 05 | NC | MEDICAID | 76390 | 01 | NC | BCBS | OTHER | 8897879 | 01 | NC | CIGNA | OTHER | 36006 | 01 | NC | MEDCOST | OTHER |