Individual
SIMA GOPAL MISTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11603 STATE AVE STE G, PROVIDENCE MEDICAL GROUP MARYSVILLE CLINIC, MARYSVILLE, WA 98271-8465
(360) 658-6800
(360) 658-6819
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 366-2983
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
60403767
WA
208000000X
Pediatrics Physician
Primary
60403767
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1926710
—
LA
01
—
MD60403767
WSL
WA
Enumeration date
04/09/2009
Last updated
02/18/2015
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