Provider Demographics
NPI:1417016841
Name:DR EARL S KIMBELL III DO PC
Entity Type:Organization
Organization Name:DR EARL S KIMBELL III DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIMBELL
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:602-942-6944
Mailing Address - Street 1:13825 N 7TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4342
Mailing Address - Country:US
Mailing Address - Phone:602-942-6944
Mailing Address - Fax:602-942-6946
Practice Address - Street 1:13825 N 7TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4342
Practice Address - Country:US
Practice Address - Phone:602-942-6944
Practice Address - Fax:602-942-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3489261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101082Medicare PIN
AZH15187Medicare UPIN