Provider Demographics
NPI:1750571592
Name:SIMS, JOSEPH A (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:SIMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WESTOVER DR # 11112
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-8941
Mailing Address - Country:US
Mailing Address - Phone:631-380-8050
Mailing Address - Fax:
Practice Address - Street 1:1000 BLUEBIRD VW UNIT 1106
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2258
Practice Address - Country:US
Practice Address - Phone:631-380-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007004102207Q00000X
TXK2593207Q00000X
PAOS011911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO# PENDINGMedicaid
ARPENDINGOtherAR BLUE SHIELD #
ARPENDINGOtherAR BLUE SHIELD #