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1205917374

NPI Code Detail

MEDICARE: JON POTTER KIMBALL MD

MEDICARE: JON POTTER KIMBALL MD

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
1	207X00000X	Orthopaedic Surgery Physician	2013-00103	NC
2	207X00000X	Orthopaedic Surgery Physician	ME96185	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17EIV	OTHER	FL	BCBS
2	177VX	OTHER	NC	BCBSNC PROVIDER ID NUMBER
3	856543	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1205917374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON POTTER KIMBALL MD

Provider Business Mailing Address
First Line	:	1988 GULF TO BAY BLVD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3550
Country	:	US
Telephone Number	:	727-953-8090
Fax Number	:	727-953-8088

Provider Business Practice Location Address
First Line	:	1988 GULF TO BAY BLVD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3550
Country	:	US
Telephone Number	:	727-953-8090
Fax Number	:	727-953-8088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/30/2022

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Directions to “ JON POTTER KIMBALL MD” Practice Location

Language	Start Address	Practice Location

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