Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 28948 | MN |
NPI | 1063417012 |
---|---|
Provider Name | Dr. Barry Paul Kimberley |
First Address | Newton, KS 67114-7808 |
Second Address | Newton, KS 67114-7808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 25/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200577150A | (05) | KS |
759469100 | (05) | MN |