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General NPI Number Information
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NPI Number | 1952352239
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Entity Type | Individual
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Provider Name | KIMBERLY GRANT MANSELL DO
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2500 HARBOR BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5000
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Country | US
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Telephone | 941-625-4155
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Fax | 941-625-4155
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Provider Business Mailing Address
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Address Line | PO BOX 510209
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City | PUNTA GORDA
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State | FL
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Zip | 33951-0209
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Country | US
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Telephone | 941-347-8317
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A-1350-06
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License Number State | NM
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