Provider Demographics
NPI:1952392516
Name:SIMSON, J. MITCHELL (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:MITCHELL
Last Name:SIMSON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:MITCHELL
Other - Last Name:SIMSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:1933 BRADBURY DRIVE SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2235
Practice Address - Country:US
Practice Address - Phone:505-272-3850
Practice Address - Fax:505-272-8018
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81-316207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP5388Medicaid
NMD35970Medicare UPIN
NMP5388Medicaid