MEDICARE: DR. JEFF A SIMERVILLE 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	208800000X	Urology Physician	MD33418	DC
2	208800000X	Urology Physician	5652	AK

General Provider Information

NPI Number	:	1871575506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFF A SIMERVILLE MD

Provider Business Mailing Address
First Line	:	2490 S WOODWORTH LOOP
Second Line	:	STE 401
City	:	PALMER
State	:	AK
Zip	:	99645-7411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2490 S WOODWORTH LOOP
Second Line	:	SUITE 401
City	:	PALMER
State	:	AK
Zip	:	99645-7405
Country	:	US
Telephone Number	:	907-745-9300
Fax Number	:

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	04/27/2016

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