Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | M862 | SD |
N | 1223S0112X | Oral and Maxillofacial Surgeon | SD4237 | SD |
NPI | 1104984483 |
---|---|
Provider Name | Carl Mccamey Kimbler |
First Address | Aberdeen, SD 57401-4601 |
Second Address | Aberdeen, SD 57401-4601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 25/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006084 | BLUE CROSS (01) | SD |
41240 | (05) | ND |
8000400 | (05) | SD |
U67637 | (02) |