Healthcare Provider Details

I. General information

NPI: 1124075122
Provider Name (Legal Business Name): JONATHAN T SIMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST STE 330
EUGENE OR
97401-8110
US

IV. Provider business mailing address

445 HARLOW RD STE 200
SPRINGFIELD OR
97477-1341
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-2538
  • Fax:
Mailing address:
  • Phone: 413-027-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60182987
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME19998
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME89998
License Number StateFL

VII. Legacy identifiers

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

# 1
Identifier275403700
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 2
Identifier53061
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: