Provider Demographics
NPI:1245220631
Name:MOHS, KIMBERLY S (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MOHS
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 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-6843
Mailing Address - Fax:505-368-6103
Practice Address - Street 1:US HWY 491 NORTH
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-6843
Practice Address - Fax:505-368-6103
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67303374Medicaid
AZ485608Medicaid
NM76921Medicaid
H47186Medicare UPIN
320059Medicare Oscar/Certification
CO67303374Medicaid