Provider Demographics
NPI:1851503411
Name:SIMPSON, FRIDAY G (MD)
Entity Type:Individual
Prefix:
First Name:FRIDAY
Middle Name:G
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1328
Mailing Address - Country:US
Mailing Address - Phone:304-522-0252
Mailing Address - Fax:304-525-4055
Practice Address - Street 1:2627 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1328
Practice Address - Country:US
Practice Address - Phone:304-522-0252
Practice Address - Fax:304-525-4055
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0053702000Medicaid
OH0972836Medicaid
WVF60574Medicare UPIN
WV0053702000Medicaid