Provider Demographics
NPI:1013968346
Name:TIBBS, KIMBERLY R (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:R
Last Name:TIBBS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1901 N UNION BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-7200
Mailing Address - Country:US
Mailing Address - Phone:719-278-3627
Mailing Address - Fax:719-623-2101
Practice Address - Street 1:9480 BRIAR VILLAGE PT
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7922
Practice Address - Country:US
Practice Address - Phone:719-278-3627
Practice Address - Fax:719-623-2101
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO39972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G66649Medicare UPIN