Provider Demographics
NPI:1649343146
Name:SIMPSON, TERRY LIDVIN (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LIDVIN
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2392 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2416
Mailing Address - Country:US
Mailing Address - Phone:805-620-1000
Mailing Address - Fax:805-209-2741
Practice Address - Street 1:760 LAS POSAS RD STE C
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2910
Practice Address - Country:US
Practice Address - Phone:805-620-1000
Practice Address - Fax:805-209-2741
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21784208600000X
CAG152805208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ148256OtherHEALTHCHOICE
AZ148256Medicaid
AZ0033504OtherHEALTHNET
AZ5077480OtherAETNA
AZ148256Medicaid
AZAZ0805530OtherBCBS
AZ5077480OtherAETNA
MD21784Medicare ID - Type Unspecified