Provider Demographics
NPI:1326006925
Name:KIMMINS, MARK HAMISH (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:HAMISH
Last Name:KIMMINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 DEBARR RD
Mailing Address - Street 2:STE 280
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-222-1401
Mailing Address - Fax:907-222-1402
Practice Address - Street 1:2751 DEBARR RD
Practice Address - Street 2:STE 280
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-222-1401
Practice Address - Fax:907-222-1402
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037698208C00000X
AK6065208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1326006925OtherNPI
AK1033128335OtherGROUP NPI
AKMD3928Medicaid
H17372Medicare UPIN
AKMD3928Medicaid