Provider Demographics
NPI:1629036546
Name:SIMISON, ANITA T (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:T
Last Name:SIMISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4251 RIVER CENTER CT NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7549
Mailing Address - Country:US
Mailing Address - Phone:319-369-7397
Mailing Address - Fax:319-369-8639
Practice Address - Street 1:4251 RIVER CENTER CT NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7549
Practice Address - Country:US
Practice Address - Phone:319-369-7397
Practice Address - Fax:319-369-8639
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA36342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0451773Medicaid
IAI17122Medicare ID - Type Unspecified
IA0451773Medicaid