Provider Demographics
NPI:1487673687
Name:GIFFARD, KIMBERLY A (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:GIFFARD
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 1:266 S MOON AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5711
Mailing Address - Country:US
Mailing Address - Phone:813-655-4700
Mailing Address - Fax:
Practice Address - Street 1:4051 UPPER CREEK DR STE 108
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6825
Practice Address - Country:US
Practice Address - Phone:813-634-9264
Practice Address - Fax:813-634-8578
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225865208600000X
FLME101901208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5175H1Medicare PIN
NYI48432Medicare UPIN
NY5175H1Medicare PIN
FLI48432Medicare UPIN