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General NPI Number Information
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NPI Number | 1275633844
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Entity Type | Individual
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Provider Name | SAMUEL K SIM MD
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1 MEDICAL PARK BLVD
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City | BRISTOL
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State | TN
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Zip | 37620-7430
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Country | US
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Telephone | 423-844-1121
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 SE 164TH AVE STE 205
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City | VANCOUVER
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State | WA
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Zip | 98683-9313
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Country | US
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Telephone | 360-946-4313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 129513
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | EMC0004965
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD-12112
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License Number State | HI
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 77301
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD00032743
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License Number State | WA
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