Provider Demographics
NPI:1619113925
Name:SIMS, DEANDREA (MD)
Entity Type:Individual
Prefix:
First Name:DEANDREA
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6005
Mailing Address - Country:US
Mailing Address - Phone:209-946-6800
Mailing Address - Fax:209-946-6805
Practice Address - Street 1:1901 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6005
Practice Address - Country:US
Practice Address - Phone:209-946-6800
Practice Address - Fax:209-946-6805
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106325208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery