Provider Demographics
NPI:1528013778
Name:SIMS, DAVID PAUL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
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 1:170 ALAMEDA DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-6231
Mailing Address - Country:US
Mailing Address - Phone:321-794-2476
Mailing Address - Fax:321-454-6370
Practice Address - Street 1:170 ALAMEDA DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952
Practice Address - Country:US
Practice Address - Phone:321-794-2476
Practice Address - Fax:321-454-6370
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD83110208G00000X
TXS0093208G00000X
IL036.146554208G00000X
MT66636208G00000X
IA45300208G00000X
IN01080320A208G00000X
NE30809208G00000X
CO0060435208G00000X
FLME 75615208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255089000Medicaid
G70653Medicare UPIN
FL255089000Medicaid
FL590688798027OtherTRICARE
FL43597OtherBCBS
G70653Medicare UPIN
FL43597BMedicare ID - Type Unspecified