Healthcare Provider Details

I. General information

NPI: 1215917075
Provider Name (Legal Business Name): P B SIMPSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 W 40TH AVE SUITE 501
PINE BLUFF AR
71603-6319
US

IV. Provider business mailing address

1609 W 40TH AVE SUITE 501
PINE BLUFF AR
71603-6319
US

V. Phone/Fax

Practice location:
  • Phone: 870-536-8547
  • Fax: 870-536-6452
Mailing address:
  • Phone: 870-536-8547
  • Fax: 870-536-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR2287
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberR2287
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: