Healthcare Provider Details

I. General information

NPI: 1689738072
Provider Name (Legal Business Name): BRIAN KIMBRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 59TH ST W TRAUMA SERVICE
BRADENTON FL
34209-4604
US

IV. Provider business mailing address

2020 59TH ST W TRAUMA SERVICE
BRADENTON FL
34209-4604
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-6611
  • Fax:
Mailing address:
  • Phone: 941-792-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA67135
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME108032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: