Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | ||
N | 175L00000X | Homeopath | ||
N | 208200000X | Surgeon | DR49586 | CO |
N | 208600000X | Surgeon | DR49586 | CO |
Y | 208D00000X | General Practice Physician | DR49586 | CO |
NPI | 1841337110 |
---|---|
Provider Name | Traci A. Kimball |
First Address | Englewood, CO 80110-6541 |
Second Address | Englewood, CO 80110-6541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 27/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
418235ZPRB | (02) | CO |
98159241 | (05) | CO |