Healthcare Provider Details

I. General information

NPI: 1225011208
Provider Name (Legal Business Name): DAVID NICHOLAS SIMCOE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 OAK HILL RD
WILLISTON VT
05495-7134
US

IV. Provider business mailing address

586 OAK HILL RD
WILLISTON VT
05495-7134
US

V. Phone/Fax

Practice location:
  • Phone: 802-878-8131
  • Fax: 802-879-6853
Mailing address:
  • Phone: 802-878-8131
  • Fax: 802-879-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02002376
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0320000562
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: