Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD048645L | PA |
NPI | 1205808631 |
---|---|
Provider Name | Dr. Robert Monroe Kimmel |
First Address | Pottsville, PA 17901-3711 |
Second Address | Pottsville, PA 17901-3711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 30/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F80349 | (02) | PA |