Individual
KIMBERLEE BIZZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D69556
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
418440800
—
MD
01
—
954072-01 & 02
BLUE CROSS/BLUE SHIELD
MD
01
—
S062-0367
BLUE CROSS/BLUE SHIELD - REGIONAL
MD
Enumeration date
05/17/2007
Last updated
09/24/2010
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