Provider Demographics
NPI:1003935388
Name:SIMPSON, TAMARA SHANNAN (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:SHANNAN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2825 E BARNETT RD
Mailing Address - Street 2:MSS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-789-4207
Mailing Address - Fax:541-789-4806
Practice Address - Street 1:537 SW UNION AVE., 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5788
Practice Address - Country:US
Practice Address - Phone:541-507-2050
Practice Address - Fax:541-474-5009
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047379207XX0801X
ORMD21283207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8479297Medicaid
G8879226Medicare PIN
ORH56246Medicare UPIN