Provider Demographics
NPI:1558363945
Name:KIMBALL, DEBRA ANN (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:KIMBALL
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 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:2380 NW 152ND ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4514
Practice Address - Country:US
Practice Address - Phone:515-237-3974
Practice Address - Fax:515-883-2692
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA231432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0246728Medicaid
A02123Medicare UPIN
IAI4297Medicare UPIN