Provider Demographics
NPI:1861484016
Name:SIMPSON, JERRY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALLEN
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 1:2117 JUBILEE LN
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9706
Mailing Address - Country:US
Mailing Address - Phone:252-756-0485
Mailing Address - Fax:
Practice Address - Street 1:850 W H SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3763
Practice Address - Country:US
Practice Address - Phone:252-758-3211
Practice Address - Fax:252-758-1811
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600196207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC126KMOtherBCBS
NC89126KMMedicaid
NC89126KMMedicaid
NC2280595DMedicare ID - Type Unspecified