Provider Demographics
NPI:1134381650
Name:SIMPSON, ERIC E (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:E
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 1ST ST STE 153
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3175
Mailing Address - Country:US
Mailing Address - Phone:815-285-5484
Mailing Address - Fax:815-285-5486
Practice Address - Street 1:215 E 1ST ST STE 153
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3175
Practice Address - Country:US
Practice Address - Phone:815-285-5484
Practice Address - Fax:815-285-5486
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036147336208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036147336Medicaid
ILF400504224OtherMEDICARE PTAN