Provider Demographics
NPI:1891776563
Name:KIMURA, STEPHEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
Last Name:KIMURA
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 1:8333 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6049
Mailing Address - Country:US
Mailing Address - Phone:850-474-8100
Mailing Address - Fax:850-474-8083
Practice Address - Street 1:5401 CORPORATE WOODS DR STE 100
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8974
Practice Address - Country:US
Practice Address - Phone:850-969-2340
Practice Address - Fax:850-969-2345
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20878207RA0201X
FLME0076685207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F36505Medicare UPIN