Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 68514421205 | UT |
N | 111NI0900X | Internist | 68514421205 | UT |
Y | 207RA0401X | Internist - Addiction Medicine | 68514421205 | UT |
NPI | 1629247358 |
---|---|
Provider Name | Dr. Chad Brigham Kimball |
First Address | Provo, UT 84604-5277 |
Second Address | Provo, UT 84604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2008 |
Last Update Date | 25/06/2019 |