Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 207720 | MA |
N | 2086S0105X | Surgery of the Hand | 207720 | MA |
NPI | 1104870476 |
---|---|
Provider Name | Dr. Hervey L. Kimball III |
First Address | Roxbury Crossing, MA 02120-2847 |
Second Address | Roxbury Crossing, MA 02120-2847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 23/01/2014 |