=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740488238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY LUCIEN SIMPSON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2007
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2335 E KASHIAN LN STE 208
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93701-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-320-1090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2625 E DIVISADERO ST
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93721-1431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-443-2682
-----------------------------------------------------
Fax | 559-443-2681
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | A112941
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------