MEDICARE: DR. MATTHEW SHANE SIMPSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L3834	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01626932	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8FT500	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518055433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW SHANE SIMPSON MD

Provider Business Mailing Address
First Line	:	8850 SIX PINES DR
Second Line	:	SUITE 270
City	:	SHENANDOAH
State	:	TX
Zip	:	77380-2683
Country	:	US
Telephone Number	:	936-597-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	21105 EVA ST
Second Line	:	SUITE 100
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-1706
Country	:	US
Telephone Number	:	936-597-8585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	04/06/2017

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