Provider Demographics
NPI:1376557942
Name:THURMOND, KIMBERLY TYXINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:TYXINE
Last Name:THURMOND
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ELMER RD
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1202
Mailing Address - Country:US
Mailing Address - Phone:781-335-0433
Mailing Address - Fax:
Practice Address - Street 1:45 DIMOCK ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1208
Practice Address - Country:US
Practice Address - Phone:617-442-8800
Practice Address - Fax:617-442-4088
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2180213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY71094OtherBLUE CROSS BLUE SHIELD
MA0362280Medicaid
MA480033626OtherMEDICARE RAILROAD
MAY71094OtherBLUE CROSS BLUE SHIELD
MAU71984Medicare UPIN