Healthcare Provider Details

I. General information

NPI: 1093792442
Provider Name (Legal Business Name): BERT E SIMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PETERSON ROAD
KNOXVILLE TN
37934-0109
US

IV. Provider business mailing address

PO BOX 1518 FIRST MED INC
PIGEON FORGE TN
37868-1518
US

V. Phone/Fax

Practice location:
  • Phone: 865-446-4032
  • Fax: 868-868-4746
Mailing address:
  • Phone: 865-446-4032
  • Fax: 865-868-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37709
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: