Individual
JON POTTER KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1988 GULF TO BAY BLVD, CLEARWATER, FL 33765-3550
(727) 953-8090
(727) 953-8088
Mailing address
1988 GULF TO BAY BLVD, CLEARWATER, FL 33765-3550
(727) 953-8090
(727) 953-8088
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2013-00103
NC
207X00000X
Orthopaedic Surgery Physician
Primary
ME96185
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177VX
BCBSNC PROVIDER ID NUMBER
NC
01
—
17EIV
BCBS
FL
01
—
856543
CIGNA
FL
Enumeration date
10/17/2006
Last updated
06/30/2022
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