Healthcare Provider Details

I. General information

NPI: 1750371894
Provider Name (Legal Business Name): DAVID N. SIM, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6014 W EMERALD ST
BOISE ID
83704-8855
US

IV. Provider business mailing address

6014 W EMERALD ST
BOISE ID
83704-8855
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-8666
  • Fax: 208-376-9804
Mailing address:
  • Phone: 208-376-8666
  • Fax: 208-376-9804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberM3561
License Number StateID

VIII. Authorized Official

Name: DR. DAVID NEIL SIM
Title or Position: CARDIOLOGIST
Credential: M.D.,P.A.
Phone: 208-376-8666