Provider Demographics
NPI:1043715659
Name:KIMMIS, BROOKS DAVID (MD, MAY 2018)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:DAVID
Last Name:KIMMIS
Suffix:
Gender:M
Credentials:MD, MAY 2018
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:E GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5098
Mailing Address - Country:US
Mailing Address - Phone:401-715-2217
Mailing Address - Fax:
Practice Address - Street 1:1672 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:E GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5098
Practice Address - Country:US
Practice Address - Phone:401-715-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD18034207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology