Provider Demographics
NPI:1477503928
Name:SIMPSON, FREDERICK R (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:R
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 1:1103 FAIRINGTON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8130
Mailing Address - Country:US
Mailing Address - Phone:937-497-5561
Mailing Address - Fax:937-497-5565
Practice Address - Street 1:1103 FAIRINGTON DR STE 100
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8130
Practice Address - Country:US
Practice Address - Phone:937-497-5561
Practice Address - Fax:937-497-5565
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-2881-S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2078237Medicaid
OHG78339Medicare UPIN
OH2078237Medicaid