Provider Demographics
NPI:1942539606
Name:KIMBERLEA A ROE, M.D., P.A.
Entity Type:Organization
Organization Name:KIMBERLEA A ROE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-478-2221
Mailing Address - Street 1:418 N MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5447
Mailing Address - Country:US
Mailing Address - Phone:214-478-2221
Mailing Address - Fax:
Practice Address - Street 1:418 N MONTCLAIR AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5447
Practice Address - Country:US
Practice Address - Phone:214-478-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2112207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029805102Medicaid