Provider Demographics
NPI:1295734531
Name:SIMPSON, WILBUR CANNON (MD)
Entity type:Individual
Prefix:
First Name:WILBUR
Middle Name:CANNON
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 1:7051 SOUTHPOINT PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8709
Mailing Address - Country:US
Mailing Address - Phone:904-493-2229
Mailing Address - Fax:904-396-4546
Practice Address - Street 1:7051 SOUTHPOINT PKWY S STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8713
Practice Address - Country:US
Practice Address - Phone:904-493-2229
Practice Address - Fax:904-396-4546
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0028706207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036441000Medicaid
FLD52574Medicare UPIN
FL15421Medicare ID - Type Unspecified