Provider Demographics
NPI:1154548410
Name:SIMPAO, JOSE RODRIQUEZ JR (MD,)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RODRIQUEZ
Last Name:SIMPAO
Suffix:JR
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 1:6850 N DURANGO DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4596
Mailing Address - Country:US
Mailing Address - Phone:702-944-4028
Mailing Address - Fax:702-826-4244
Practice Address - Street 1:6850 N DURANGO DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4596
Practice Address - Country:US
Practice Address - Phone:702-944-4028
Practice Address - Fax:702-826-4244
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1623982080A0000X, 208D00000X
NV160602080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice