Provider Demographics
NPI:1659505030
Name:BOCK TABOR, KIMBERLEY DAWN (IDMT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:DAWN
Last Name:BOCK TABOR
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:NEW EGYPT
Mailing Address - State:NJ
Mailing Address - Zip Code:08533-2718
Mailing Address - Country:US
Mailing Address - Phone:210-383-0748
Mailing Address - Fax:
Practice Address - Street 1:3453 NEELY RD
Practice Address - Street 2:
Practice Address - City:MCGUIRE AFB
Practice Address - State:NJ
Practice Address - Zip Code:08641
Practice Address - Country:US
Practice Address - Phone:609-754-9177
Practice Address - Fax:609-754-9177
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians