Provider Demographics
NPI:1407837891
Name:SIMPSON, MARK THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:SIMPSON
Suffix:
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:PO BOX 8667
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-0667
Mailing Address - Country:US
Mailing Address - Phone:423-899-2204
Mailing Address - Fax:423-698-4045
Practice Address - Street 1:4513 HIXSON PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5039
Practice Address - Country:US
Practice Address - Phone:423-877-7999
Practice Address - Fax:423-877-7901
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN19467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC68963Medicare UPIN
TN3047407Medicare ID - Type Unspecified