Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 17153 | IA |
NPI | 1003004136 |
---|---|
Provider Name | Dr. James David Kimball |
First Address | Osceola, IA 50213-1604 |
Second Address | Osceola, IA 50213-1604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2007 |
Last Update Date | 15/10/2007 |