Healthcare Provider Details

I. General information

NPI: 1063417012
Provider Name (Legal Business Name): BARRY PAUL KIMBERLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEDICAL CENTER DR SUITE 230
NEWTON KS
67114-7808
US

IV. Provider business mailing address

800 MEDICAL CENTER DR SUITE 230
NEWTON KS
67114-7808
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-2828
  • Fax: 316-283-2830
Mailing address:
  • Phone: 316-283-2828
  • Fax: 316-283-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number28948
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number28948
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: