Provider Demographics
NPI:1063668747
Name:SIMPSON, GARY ALEXANDER (DO)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALEXANDER
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4105 BRIARGATE PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3487
Mailing Address - Country:US
Mailing Address - Phone:719-473-3332
Mailing Address - Fax:719-368-6872
Practice Address - Street 1:4105 BRIARGATE PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3487
Practice Address - Country:US
Practice Address - Phone:719-473-3332
Practice Address - Fax:719-368-6872
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVSL0580207R00000X
CODR0053689207X00000X
OH34010234207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66021774Medicaid
OH0083504Medicaid
H210970Medicare PIN