Provider Demographics
NPI:1932211083
Name:ISSEN, SIMA GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMA
Middle Name:GAIL
Last Name:ISSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:32 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3602
Practice Address - Country:US
Practice Address - Phone:509-626-9825
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA25130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA67571Medicare UPIN