Provider Demographics
NPI:1164471439
Name:SIMS, SHANNON W (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:W
Last Name:SIMS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8080 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 1650
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1838
Mailing Address - Country:US
Mailing Address - Phone:972-860-8648
Mailing Address - Fax:972-860-8679
Practice Address - Street 1:4927 LAKE RIDGE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:972-641-9000
Practice Address - Fax:972-641-9002
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TXK3009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG50582Medicare UPIN
TX8G1305Medicare ID - Type Unspecified