Provider Demographics
NPI:1114998721
Name:SIMPSON, RUSSELL EDWIN III (MD)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:EDWIN
Last Name:SIMPSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8549 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-1826
Mailing Address - Country:US
Mailing Address - Phone:626-308-7513
Mailing Address - Fax:
Practice Address - Street 1:1060 E GREEN ST STE 204
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2431
Practice Address - Country:US
Practice Address - Phone:626-308-7513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8372118OtherMEDICAL PIN
CA00G278951Medicaid
CA00G278951Medicaid
CAG27895AMedicare ID - Type Unspecified