MEDICARE: KIMBERLY MARONEY, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L1379	TX

General Provider Information

NPI Number	:	1639114119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY MARONEY, M.D., P.A.

Provider Business Mailing Address
First Line	:	400 ENTERPRISE BLVD
Second Line	:	SUITE 2
City	:	ROCKPORT
State	:	TX
Zip	:	78382-4333
Country	:	US
Telephone Number	:	361-729-0133
Fax Number	:	361-729-0855

Provider Business Practice Location Address
First Line	:	400 ENTERPRISE BLVD
Second Line	:	SUITE 2
City	:	ROCKPORT
State	:	TX
Zip	:	78382-4333
Country	:	US
Telephone Number	:	361-729-0133
Fax Number	:	361-729-0855

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	KIMBERLY MARONEY
Credential	:	M.D.
Telephone Number	:	361-729-0133

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/22/2020

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