Provider Demographics
NPI:1275822942
Name:SIMPSON, GARY LAVERN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LAVERN
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SENDA ALIENTO DR
Mailing Address - Street 2:18 SENDA ALIENTO
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-9530
Mailing Address - Country:US
Mailing Address - Phone:505-867-3946
Mailing Address - Fax:
Practice Address - Street 1:18 SENDA ALIENTO DR
Practice Address - Street 2:18 SENDA ALIENTO
Practice Address - City:PLACITAS
Practice Address - State:NM
Practice Address - Zip Code:87043-9530
Practice Address - Country:US
Practice Address - Phone:505-867-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79-276207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease