Provider Demographics
NPI:1215917075
Name:SIMPSON, P B JR (MD)
Entity type:Individual
Prefix:
First Name:P
Middle Name:B
Last Name:SIMPSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1609 W 40TH AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6319
Mailing Address - Country:US
Mailing Address - Phone:870-536-8547
Mailing Address - Fax:870-536-6452
Practice Address - Street 1:1609 W 40TH AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6319
Practice Address - Country:US
Practice Address - Phone:870-536-8547
Practice Address - Fax:870-536-6452
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARR2287174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102951001Medicaid
AR54873Medicare UPIN
AR54873DH13Medicare UPIN