Healthcare Provider Details

I. General information

NPI: 1346299559
Provider Name (Legal Business Name): G EDWARD KIMM JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 OGDEN ST STE 400
DENVER CO
80218-3670
US

IV. Provider business mailing address

500 ELDORADO BLVD # 6250
BROOMFIELD CO
80021-3408
US

V. Phone/Fax

Practice location:
  • Phone: 303-318-1540
  • Fax: 303-318-3825
Mailing address:
  • Phone: 303-272-0751
  • Fax: 303-318-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number31626
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: