Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 279303 | MA |
N | 207X00000X | Orthopaedic Surgeon | 47474 | CO |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME120354 | FL |
NPI | 1629208210 |
---|---|
Provider Name | Dr. Kimberly K Broughton |
First Address | Eglin Afb, FL 32542-1302 |
Second Address | Eglin Afb, FL 32542-1302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2009 |
Last Update Date | 24/08/2020 |