Provider Demographics
NPI:1871575506
Name:SIMERVILLE, JEFF A (MD)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:A
Last Name:SIMERVILLE
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 1:2490 S WOODWORTH LOOP
Mailing Address - Street 2:STE 401
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2490 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 401
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7405
Practice Address - Country:US
Practice Address - Phone:907-745-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33418208800000X
AK5652208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology