Provider Demographics
NPI:1346228616
Name:SIMS, WILBUR CALDWELL (MD)
Entity Type:Individual
Prefix:
First Name:WILBUR
Middle Name:CALDWELL
Last Name:SIMS
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 1:8599 HAVEN AVE.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4849
Mailing Address - Country:US
Mailing Address - Phone:909-620-8180
Mailing Address - Fax:909-919-7288
Practice Address - Street 1:8599 HAVEN AVE.
Practice Address - Street 2:SUITE 300
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4849
Practice Address - Country:US
Practice Address - Phone:909-620-8180
Practice Address - Fax:909-919-7288
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG141512085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G141510Medicaid
CACG1263OtherRAILROAD MEDICARE
CA00G141511Medicare PIN
CA00G141510Medicare PIN
CA00G141510Medicaid
CA00G141517Medicare PIN
CA00G141518Medicare PIN
CA00G141519Medicare PIN
CA00G141516Medicare PIN
CA00G141514Medicare PIN
CACG1263OtherRAILROAD MEDICARE
CAA39180Medicare UPIN
CA00G1415111Medicare PIN
CA00G1415112Medicare PIN