Provider Demographics
NPI:1144879628
Name:SIMPSON, WILLIAM THEODORE (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THEODORE
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 SE CORA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3336
Mailing Address - Country:US
Mailing Address - Phone:503-929-5728
Mailing Address - Fax:
Practice Address - Street 1:2230 NW PETTYGROVE ST STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2659
Practice Address - Country:US
Practice Address - Phone:503-223-6223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant