Provider Demographics
NPI:1215051628
Name:SIMPSON, TODD R (DO)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:R
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4275 S THOMPSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-1006
Mailing Address - Country:US
Mailing Address - Phone:479-308-6700
Mailing Address - Fax:479-358-9887
Practice Address - Street 1:4275 S THOMPSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-1006
Practice Address - Country:US
Practice Address - Phone:479-308-6700
Practice Address - Fax:479-358-9887
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE0141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR12239OtherQUALCHOICE
MO207311200Medicaid
AR126229003Medicaid
2885742OtherDFEC
172642500OtherOWC
2885742OtherDFEC