Provider Demographics
NPI:1346299559
Name:KIMM, G EDWARD JR (MD)
Entity Type:Individual
Prefix:MR
First Name:G
Middle Name:EDWARD
Last Name:KIMM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 ELDORADO BLVD # 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:1960 OGDEN ST STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3670
Practice Address - Country:US
Practice Address - Phone:303-318-1540
Practice Address - Fax:303-318-3825
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO31626208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01316264Medicaid
F26749Medicare UPIN
COCOA101137Medicare PIN