Healthcare Provider Details

I. General information

NPI: 1326076548
Provider Name (Legal Business Name): JASON P KIMBALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MAINE ST
LAWRENCE KS
66044-1360
US

IV. Provider business mailing address

325 MAINE ST
LAWRENCE KS
66044-1360
US

V. Phone/Fax

Practice location:
  • Phone: 785-505-6100
  • Fax: 785-505-2874
Mailing address:
  • Phone: 785-505-6100
  • Fax: 785-505-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-28700
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number41025
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: