Provider Demographics
NPI:1427011535
Name:KIMBRO, LAURA THERESE (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:THERESE
Last Name:KIMBRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 LAKEWOOD DR
Mailing Address - Street 2:SUITE 23
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7856
Mailing Address - Country:US
Mailing Address - Phone:707-892-2146
Mailing Address - Fax:707-892-2152
Practice Address - Street 1:8911 LAKEWOOD DR
Practice Address - Street 2:SUITE 23
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7856
Practice Address - Country:US
Practice Address - Phone:707-892-2146
Practice Address - Fax:707-892-2152
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13382207VG0400X
AZ2950207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ319443Medicaid
AZ319443Medicaid
WMBFR03Medicare PIN