Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3489 | AZ |
Y | 207Q00000X | Family Doctor | 2010023062 | MO |
NPI | 1437189305 |
---|---|
Provider Name | Dr. Earl S Kimbell III |
First Address | San Fidel, NM 87049-0130 |
Second Address | Acoma, NM 87034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 12/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H3451 | (05) | NM |