Provider Demographics
NPI:1669937199
Name:SIMS, GREGORY (PA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SIMS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 LADY MOON DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-4426
Mailing Address - Country:US
Mailing Address - Phone:520-874-4069
Mailing Address - Fax:970-744-5350
Practice Address - Street 1:4700 LADY MOON DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-4426
Practice Address - Country:US
Practice Address - Phone:970-821-4500
Practice Address - Fax:970-744-5350
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA2097363AM0700X
COPA.0005651363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical