Healthcare Provider Details

I. General information

NPI: 1952392516
Provider Name (Legal Business Name): J. MITCHELL SIMSON MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J. MITCHELL SIMSON MD, MPH

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2235
US

IV. Provider business mailing address

1933 BRADBURY DRIVE SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3850
  • Fax: 505-272-8018
Mailing address:
  • Phone: 505-272-3120
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number81-316
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: