Healthcare Provider Details

I. General information

NPI: 1093967044
Provider Name (Legal Business Name): JOHN CHRISTOPHER SIMS IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

4955 CROWN STREET
COCOA FL
32927
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7745
  • Fax:
Mailing address:
  • Phone: 321-615-4605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: