Provider Demographics
NPI:1952394652
Name:VERNON, KIM D (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:D
Last Name:VERNON
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 1:7777 FOREST LN
Mailing Address - Street 2:BLDG D-570
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-4660
Mailing Address - Fax:972-566-6413
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:BLDG D-570
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-4660
Practice Address - Fax:972-566-6413
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4634207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX892931Medicare ID - Type Unspecified
TXB27400Medicare UPIN