Provider Demographics
NPI:1720483639
Name:SIMS, JANET (LMT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 CAMP BAKER RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-9606
Mailing Address - Country:US
Mailing Address - Phone:541-261-7073
Mailing Address - Fax:
Practice Address - Street 1:2240 CAMP BAKER RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-9606
Practice Address - Country:US
Practice Address - Phone:541-261-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty