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General NPI Number Information
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NPI Number | 1710285630
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Entity Type | Individual
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Provider Name | DUSTIN SIMPSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 1100 WILFORD HALL LOOP, BLDG 4554 ATTN: 59 MDW/SGHC
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City | JBSA LACKLAND
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State | TX
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Zip | 78236
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Country | US
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Telephone | 210-292-6225
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WILFORD HALL LOOP, BLDG 4554 ATTN: 59 MDW/SGHC
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City | JBSA LACKLAND
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State | TX
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Zip | 78236-9908
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Country | US
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Telephone | 210-292-6225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 65116-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R7893
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License Number State | TX
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