Provider Demographics
NPI:1184616880
Name:TRIMBLE, KARL KIRK (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:KIRK
Last Name:TRIMBLE
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 1:459 DEL MAR DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7984
Mailing Address - Country:US
Mailing Address - Phone:435-674-3552
Mailing Address - Fax:435-674-5905
Practice Address - Street 1:169 W 2710 SOUTH CIR STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7202
Practice Address - Country:US
Practice Address - Phone:435-674-3552
Practice Address - Fax:435-674-5905
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5645767-1205207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTI24994Medicare UPIN