Provider Demographics
NPI:1043242613
Name:VORSE, KIMBERLY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:VORSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:380 WASHINGTON AVE STE 201
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-5000
Mailing Address - Country:US
Mailing Address - Phone:208-726-0000
Mailing Address - Fax:
Practice Address - Street 1:380 WASHINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340-5000
Practice Address - Country:US
Practice Address - Phone:208-726-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-03-11
Deactivation Date:2007-05-02
Deactivation Code:
Reactivation Date:2007-11-07
Provider Licenses
StateLicense IDTaxonomies
IDM7028207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1134646Medicare PIN