Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 52364 | CO |
NPI | 1083804694 |
---|---|
Provider Name | Dr. Brent Young Kimball |
First Address | Denver, CO 80217-2263 |
Second Address | Lone Tree, CO 80124-5531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 08/07/2020 |