Healthcare Provider Details

I. General information

NPI: 1255569422
Provider Name (Legal Business Name): DALE A KIMBROUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

525 E MARKET ST
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3043
  • Fax: 330-375-7932
Mailing address:
  • Phone: 330-375-3043
  • Fax: 330-375-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35096509
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: