Healthcare Provider Details

I. General information

NPI: 1497194633
Provider Name (Legal Business Name): THOMAS J SIMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 CHAMBERS ST
EUGENE OR
97402-3706
US

IV. Provider business mailing address

1065 CHAMBERS ST
EUGENE OR
97402-3706
US

V. Phone/Fax

Practice location:
  • Phone: 541-705-2028
  • Fax:
Mailing address:
  • Phone: 541-705-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberMD08437
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD08437
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: