Provider Demographics
NPI:1215037403
Name:D'ERAMO, KIMBERLY (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:D'ERAMO
Suffix:
Gender:F
Credentials:DO
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 957
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-0957
Mailing Address - Country:US
Mailing Address - Phone:678-602-0400
Mailing Address - Fax:
Practice Address - Street 1:1022 HERITAGE RD
Practice Address - Street 2:
Practice Address - City:HESPERUS
Practice Address - State:CO
Practice Address - Zip Code:81326-8709
Practice Address - Country:US
Practice Address - Phone:678-602-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00558992083P0901X
MA239622207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA843825299BMedicaid
GA93BFBNFMedicare ID - Type UnspecifiedPROVIDER NUMBER