Provider Demographics
NPI:1710946744
Name:ORTON, KIMBALL RALPH (MD)
Entity Type:Individual
Prefix:
First Name:KIMBALL
Middle Name:RALPH
Last Name:ORTON
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 1:1100 N EL DORADO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4606
Mailing Address - Country:US
Mailing Address - Phone:520-296-7169
Mailing Address - Fax:520-885-5806
Practice Address - Street 1:1100 N EL DORADO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4606
Practice Address - Country:US
Practice Address - Phone:520-296-7169
Practice Address - Fax:520-885-5806
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ117661Medicare PIN
AZD00071Medicare UPIN