Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 18526 | AZ |
NPI | 1053381533 |
---|---|
Provider Name | Dr. David L Simms |
First Address | Phoenix, AZ 85016-4876 |
Second Address | Glendale, AZ 85306-4660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286238 | (05) | AZ |
707549 | (05) | AZ |
AZ0819080 | BC/BS PROVIDER ID (01) | AZ |
D35280 | (02) |