Individual
DR. DAVID HOMER KINGSBURY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8424 NAAB RD, SUITE 2B, INDIANAPOLIS, IN 46260-1966
(317) 872-1197
(317) 872-0027
Mailing address
10145 OSWEGO DR, INDIANAPOLIS, IN 46236-9332
(317) 823-6000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01021190A
IN
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
01021190A
IN
207NP0225X
Pediatric Dermatology Physician
01021190A
IN
207NS0135X
Procedural Dermatology Physician
01021190A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000079811
ANTHEM PIN
IN
01
—
01021190A
PHYSICIAN LICENSE
IN
01
—
01375974
TRAVELERS
IN
01
—
2035684001
CIGNA
IN
01
—
4252234
AETNA PIN
IN
Enumeration date
01/25/2007
Last updated
05/30/2008
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