Provider Demographics
NPI:1053377408
Name:SIMS, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SIMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2430 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3553
Mailing Address - Country:US
Mailing Address - Phone:575-628-5051
Mailing Address - Fax:575-628-0493
Practice Address - Street 1:2420 W PIERCE ST
Practice Address - Street 2:STE 105
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3543
Practice Address - Country:US
Practice Address - Phone:575-628-8837
Practice Address - Fax:575-628-8848
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78-261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00138263OtherRAILROAD MEDICARE
NM40626075Medicaid
NM00NM009K50OtherBCBS
NM342416800Medicare ID - Type Unspecified
NM40626075Medicaid