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General NPI Number Information
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NPI Number | 1346299559
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Entity Type | Individual
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Provider Name | G EDWARD KIMM JR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 1960 OGDEN ST STE 400
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City | DENVER
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State | CO
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Zip | 80218-3670
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Country | US
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Telephone | 303-318-1540
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Fax | 303-318-3825
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Provider Business Mailing Address
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Address Line | 500 ELDORADO BLVD # 6250
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City | BROOMFIELD
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State | CO
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Zip | 80021-3408
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Country | US
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Telephone | 303-272-0751
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Fax | 303-318-2488
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 31626
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License Number State | CO
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