Provider Demographics
NPI:1457462269
Name:PRIEBE, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PRIEBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCADO STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7311
Mailing Address - Country:US
Mailing Address - Phone:970-382-8800
Mailing Address - Fax:970-382-0122
Practice Address - Street 1:1 MERCADO STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7311
Practice Address - Country:US
Practice Address - Phone:970-382-8800
Practice Address - Fax:970-382-0122
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41199207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34323384Medicaid
CO62137239Medicaid
NM34323384Medicaid
H95294Medicare UPIN