MEDICARE: DR. TERRY LIDVIN SIMPSON MD., FACS

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	208600000X	Surgery Physician	21784	AZ
2	208600000X	Surgery Physician	G152805	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	148256	OTHER	AZ	HEALTHCHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0033504	OTHER	AZ	HEALTHNET
4	5077480	OTHER	AZ	AETNA

General Provider Information

NPI Number	:	1649343146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY LIDVIN SIMPSON MD., FACS

Provider Business Mailing Address
First Line	:	2392 FOSTER AVE
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93001-2416
Country	:	US
Telephone Number	:	805-620-1000
Fax Number	:	805-209-2741

Provider Business Practice Location Address
First Line	:	760 LAS POSAS RD STE C
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2910
Country	:	US
Telephone Number	:	805-620-1000
Fax Number	:	805-209-2741

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	01/13/2023

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