Provider Demographics
NPI:1336680545
Name:JANVIER-WITHROW, KIMBERLY N (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:JANVIER-WITHROW
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 1:140 SW 84TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2736
Mailing Address - Country:US
Mailing Address - Phone:954-476-1050
Mailing Address - Fax:954-476-2080
Practice Address - Street 1:7630 SW 34TH MNR STE 335
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1984
Practice Address - Country:US
Practice Address - Phone:954-476-1050
Practice Address - Fax:954-476-2080
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLME148361207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program