Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD10502 | TN |
NPI | 1023170925 |
---|---|
Provider Name | Dr. Clifford William Sims |
First Address | Memphis, TN 38104-3672 |
Second Address | Memphis, TN 38104-3672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3163225 | (05) | TN |
B02292 | (02) |