Provider Demographics
NPI:1114106952
Name:SIM, DAVID N (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:SIM
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6014 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8855
Mailing Address - Country:US
Mailing Address - Phone:208-376-8666
Mailing Address - Fax:208-376-8902
Practice Address - Street 1:6014 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8855
Practice Address - Country:US
Practice Address - Phone:208-376-8666
Practice Address - Fax:208-376-8902
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-3561207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID35618OtherBLUE CROSS
ID000010001844OtherBLUE SHIELD
IDA42433Medicare UPIN
ID1111330Medicare PIN