MEDICARE: DR. KIMBERLY A BRYDLE 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	207L00000X	Anesthesiology Physician	33336	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417949231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY A BRYDLE MD

Provider Business Mailing Address
First Line	:	PO BOX 52650
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85208-0133
Country	:	US
Telephone Number	:	888-206-5902
Fax Number	:	480-466-7536

Provider Business Practice Location Address
First Line	:	7508 N LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2307
Country	:	US
Telephone Number	:	888-206-5902
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	04/01/2021

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