Provider Demographics
NPI:1861578270
Name:SIMS, DOUGLAS FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:FREDERICK
Last Name:SIMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 NOKOMIS AVE S
Mailing Address - Street 2:SUITE F
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2418
Mailing Address - Country:US
Mailing Address - Phone:941-485-3166
Mailing Address - Fax:941-485-2862
Practice Address - Street 1:329 NOKOMIS AVE S
Practice Address - Street 2:SUITE F
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2418
Practice Address - Country:US
Practice Address - Phone:941-485-3166
Practice Address - Fax:941-485-2862
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10773OtherBLUE CROSS & BLUE SHIELD
D16726Medicare UPIN
FL10773OtherBLUE CROSS & BLUE SHIELD