Provider Demographics
NPI:1073538948
Name:PARHAM, KIMBERLY J (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:PARHAM
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 1:2902 RIVERCOVE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0806
Mailing Address - Country:US
Mailing Address - Phone:903-277-1587
Mailing Address - Fax:903-223-6380
Practice Address - Street 1:6600 BRYANT IRVIN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4217
Practice Address - Country:US
Practice Address - Phone:817-820-0011
Practice Address - Fax:817-820-0073
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2257207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8890B9Medicare PIN
TXG46503Medicare UPIN