Healthcare Provider Details

I. General information

NPI: 1932305596
Provider Name (Legal Business Name): PATRICIA SIMS POOLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA SIMS MD

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST DEPARTMENT OF RADIOLOGY, DIVISION OF BREAST IMAGING
BOSTON MA
02115-6110
US

IV. Provider business mailing address

4835 CREEKBEND DR
HOUSTON TX
77035-4931
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6269
  • Fax:
Mailing address:
  • Phone: 713-320-4068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMDR-5245
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberN3249
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA108383
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number250354
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: