Provider Demographics
NPI:1194789073
Name:SIMPSON, WILLIAM P (PA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:430 BATH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2637
Mailing Address - Country:US
Mailing Address - Phone:207-442-0350
Mailing Address - Fax:207-442-0355
Practice Address - Street 1:430 BATH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2637
Practice Address - Country:US
Practice Address - Phone:207-442-0350
Practice Address - Fax:207-442-0355
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001285363A00000X
KS15-0-1100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200381060DMedicaid
MEE400153181Medicare PIN
KS200381060DMedicaid