Provider Demographics
NPI:1437216306
Name:CROFTS, KIMBALL M (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBALL
Middle Name:M
Last Name:CROFTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 W 600 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1330
Mailing Address - Country:US
Mailing Address - Phone:801-785-8825
Mailing Address - Fax:801-785-8805
Practice Address - Street 1:385 W 600 N
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1330
Practice Address - Country:US
Practice Address - Phone:801-785-8825
Practice Address - Fax:801-785-8805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT318158-12052086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107007434101OtherSELECTHEALTH
UT529051510003Medicaid
UT107007434101OtherSELECTHEALTH
UT529051510003Medicaid