Provider Demographics
NPI:1205389640
Name:SIMPSON, JAIROCEY DEON JR
Entity Type:Individual
Prefix:MR
First Name:JAIROCEY
Middle Name:DEON
Last Name:SIMPSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18421 GREENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2927
Mailing Address - Country:US
Mailing Address - Phone:423-200-6879
Mailing Address - Fax:
Practice Address - Street 1:18421 GREENVIEW AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2927
Practice Address - Country:US
Practice Address - Phone:423-200-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other