Provider Demographics
NPI:1497712921
Name:SIMERVILLE, STEVEN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAMES
Last Name:SIMERVILLE
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 1:5 POMONA COURT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005
Mailing Address - Country:US
Mailing Address - Phone:719-821-6381
Mailing Address - Fax:719-564-1041
Practice Address - Street 1:5 POMONA COURT
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-4973
Practice Address - Country:US
Practice Address - Phone:719-581-7123
Practice Address - Fax:719-564-1041
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30044207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine