Provider Demographics
NPI:1245499706
Name:SIMS, JUSTIN BRETT (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BRETT
Last Name:SIMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1120 SOUTH DRIVE
Mailing Address - Street 2:FESLER HALL
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5114
Mailing Address - Country:US
Mailing Address - Phone:317-274-8282
Mailing Address - Fax:
Practice Address - Street 1:714 N SENATE AVE
Practice Address - Street 2:STE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3763
Practice Address - Country:US
Practice Address - Phone:317-715-6381
Practice Address - Fax:317-715-6472
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013779A2085R0202X
IN01072175A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01240963OtherRAILROAD MEDICARE
IN201106880Medicaid
IN201106880Medicaid