Provider Demographics
NPI:1871527754
Name:SIMPSON, CHARLES KELLEY (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KELLEY
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OLD LARAMIE TRL E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7012
Mailing Address - Country:US
Mailing Address - Phone:303-926-9800
Mailing Address - Fax:303-926-9801
Practice Address - Street 1:120 OLD LARAMIE TRL E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7012
Practice Address - Country:US
Practice Address - Phone:303-926-9800
Practice Address - Fax:303-926-9891
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO284682085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05854776Medicaid
CO01284686Medicaid
CO021766OtherKAISER COMMERCIAL NUMBER
CO840900897OtherTAX ID
CO841537239OtherTAX ID
CO841537239OtherTAX ID
E886674Medicare UPIN
COCA3838Medicare ID - Type Unspecified
CO05854776Medicaid
CO01284686Medicaid