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NPI Code Detail

MEDICARE: DR. GARY LEE KIMBLEY EDD

MEDICARE: DR. GARY LEE KIMBLEY EDD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor11682TX

General Provider Information

NPI Number : 1124196019
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY LEE KIMBLEY EDD
Provider Business Mailing Address
First Line : 5103 18TH PL
Second Line :
City : LUBBOCK
State : TX
Zip : 79416
Country : US
Telephone Number : 806-791-1929
Fax Number : 806-744-7871
Provider Business Practice Location Address
First Line : 1105 38TH
Second Line :
City : LUBBOCK
State : TX
Zip : 79412
Country : US
Telephone Number : 806-747-2664
Fax Number : 806-744-7871
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 07/08/2007

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Directions to “ DR. GARY LEE KIMBLEY EDD” Practice Location

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