Provider Demographics
NPI:1013224369
Name:SIMPSON, BENJAMIN D (PA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:D
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93656-0543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3567 W. MT. WHITNEY AVE.
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:CA
Practice Address - Zip Code:93656
Practice Address - Country:US
Practice Address - Phone:559-867-4416
Practice Address - Fax:559-867-3010
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21133363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical