Provider Demographics
NPI:1124075122
Name:SIMS, JONATHAN T (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:T
Last Name:SIMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 HARLOW RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1341
Mailing Address - Country:US
Mailing Address - Phone:413-027-7715
Mailing Address - Fax:
Practice Address - Street 1:1200 HILYARD ST STE 330
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8110
Practice Address - Country:US
Practice Address - Phone:813-974-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD601829872085R0202X
FLME199982085R0202X
FLME899982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275403700Medicaid
FL53061OtherBLUE CROSS BLUE SHIELD
ORR141493Medicare PIN
FL275403700Medicaid
FLI55052Medicare UPIN
FL53061ZMedicare PIN
AKK161791Medicare PIN
ORR141494Medicare PIN