Provider Demographics
NPI:1720057490
Name:JONGEBLOED, KIMBERLEY E (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:E
Last Name:JONGEBLOED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 MARSEILLE DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-4521
Mailing Address - Country:US
Mailing Address - Phone:251-824-4985
Mailing Address - Fax:251-824-4990
Practice Address - Street 1:13833 TAPIA AVE
Practice Address - Street 2:
Practice Address - City:BAYOU LA BATRE
Practice Address - State:AL
Practice Address - Zip Code:36509-2515
Practice Address - Country:US
Practice Address - Phone:251-824-4985
Practice Address - Fax:251-824-4990
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine