Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 036128873 | IL |
N | 207VX0201X | Gynecologic Oncologist | 45330 | CO |
NPI | 1003806514 |
---|---|
Provider Name | Dr. Ronald E Kimball |
First Address | Urbana, IL 61801-2500 |
Second Address | Urbana, IL 61801-1645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018061 | KAISER COMMERCIAL NUMBER (01) | CO |
52572731 | (05) | CO |
F25512 | (02) | CA |