Provider Demographics
NPI:1437132081
Name:BARBOLLA, KIMBERLY (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BARBOLLA
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:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-0045
Mailing Address - Country:US
Mailing Address - Phone:903-320-3200
Mailing Address - Fax:903-471-8655
Practice Address - Street 1:1600 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-6852
Practice Address - Country:US
Practice Address - Phone:903-320-3200
Practice Address - Fax:903-471-8655
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH32276Medicare UPIN
TX8045N0Medicare ID - Type Unspecified
TX144514001Medicaid