Provider Demographics
NPI:1275736837
Name:MIDDLETON, KIMBERLEY WOODHOUSE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:WOODHOUSE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:J
Other - Last Name:WOODHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1600 E JEFFERSON ST STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5645
Practice Address - Country:US
Practice Address - Phone:425-498-2272
Practice Address - Fax:425-498-2334
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60109765208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01182867OtherRAILROAD MEDICARE
WA1275736837Medicaid
WA8902630Medicare PIN