Healthcare Provider Details

I. General information

NPI: 1407916133
Provider Name (Legal Business Name): ROBERT E KIMPTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 FRESH DR STE A
MYRTLE BEACH SC
29579-4436
US

IV. Provider business mailing address

PO BOX 2128
PAWLEYS ISLAND SC
29585-2128
US

V. Phone/Fax

Practice location:
  • Phone: 854-223-4833
  • Fax: 843-492-4479
Mailing address:
  • Phone: 854-223-4831
  • Fax: 854-212-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23645
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23645
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: