Individual
BRENT P KIMBERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 216-2906
(503) 216-7106
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
DO24543
OR
208M00000X
Hospitalist Physician
Primary
DO24543
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276344
—
OR
01
—
P00451454
RR MEDICARE
OR
Enumeration date
06/08/2006
Last updated
07/22/2021
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