Provider Demographics
NPI:1427057819
Name:KIMBELL, DAVID B (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:KIMBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 W STATE ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4686
Mailing Address - Country:US
Mailing Address - Phone:330-821-3244
Mailing Address - Fax:330-868-5782
Practice Address - Street 1:1207 W STATE ST
Practice Address - Street 2:SUITE N
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4686
Practice Address - Country:US
Practice Address - Phone:330-821-3244
Practice Address - Fax:330-868-5782
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-5458-K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128633OtherANTHEM
OH2132436Medicaid
OH110194610OtherMEDICARE RAILROADERS
OH000000128633OtherANTHEM
OH000000128633OtherANTHEM