Individual
DR. DOUGLAS J KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
91 W MADISON AVE, SUITE B, BELGRADE, MT 59714-3901
(406) 388-1988
(406) 388-2488
Mailing address
91 W MADISON AVE, SUITE B, BELGRADE, MT 59714-3901
(406) 388-1988
(406) 388-2488
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
559
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048-3704
—
MT
01
—
25871
BLUE CROSS
—
01
—
5276810001
NAT SUPPLIER
—
Enumeration date
07/12/2006
Last updated
07/08/2007
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