Provider Demographics
NPI:1114911948
Name:SIMKINS, LANCE (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:SIMKINS
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 1:3335 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2200
Mailing Address - Country:US
Mailing Address - Phone:954-965-4900
Mailing Address - Fax:954-515-1236
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-721-6666
Practice Address - Fax:954-726-7862
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049215207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056569500Medicaid
FL12292Medicare PIN
E89615Medicare UPIN