Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | AL4670 | AL |
NPI | 1043308893 |
---|---|
Provider Name | Dr. Kevin Michael Sims |
First Address | Birmingham, AL 35244-3317 |
Second Address | Birmingham, AL 35244-3317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |