Provider Demographics
NPI:1255338349
Name:SIMPSON, SAMUEL LIVAUDOIS (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LIVAUDOIS
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:JMM SUITE 2525
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-3921
Mailing Address - Country:US
Mailing Address - Phone:601-815-9528
Mailing Address - Fax:601-984-6439
Practice Address - Street 1:1513 UNION AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9407
Practice Address - Country:US
Practice Address - Phone:660-263-8309
Practice Address - Fax:660-263-1948
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2024-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS20478208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207268004Medicaid
MS04329316Medicaid
MO931102372Medicare ID - Type UnspecifiedMEDICARE
MO207268004Medicaid
I30670Medicare UPIN