Provider Demographics
NPI:1871585281
Name:SIMPSON, ROGER J (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:J
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 1:106 E C ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5411
Mailing Address - Country:US
Mailing Address - Phone:308-532-6165
Mailing Address - Fax:308-532-7464
Practice Address - Street 1:106 E C ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5411
Practice Address - Country:US
Practice Address - Phone:308-532-6165
Practice Address - Fax:308-532-7464
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19441207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4028OtherBLUE CROSS/BLUE SHIELD
NE47077753103Medicaid
NE47077753101Medicaid
NE47077753102Medicaid
NE$$$$$$$$$00Medicaid
NE47077753102Medicaid