MEDICARE: ROBERT J KIMMEL 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	207Q00000X	Family Medicine Physician	7864	NV

General Provider Information

NPI Number	:	1982786943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J KIMMEL MD

Provider Business Mailing Address
First Line	:	PO BOX 21530
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89721-1530
Country	:	US
Telephone Number	:	775-884-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 PINE CONE RD
Second Line	:	STE 102
City	:	DAYTON
State	:	NV
Zip	:	89403-7393
Country	:	US
Telephone Number	:	775-884-2455
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	10/04/2007

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