Provider Demographics
NPI:1861998007
Name:KIMBROUGH, BRADLY ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:BRADLY
Middle Name:ALEXANDER
Last Name:KIMBROUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W HWY 6 STE 101
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7545
Mailing Address - Country:US
Mailing Address - Phone:254-755-4582
Mailing Address - Fax:
Practice Address - Street 1:611 W HWY 6 STE 101
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7545
Practice Address - Country:US
Practice Address - Phone:254-755-4582
Practice Address - Fax:254-755-4585
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29168207R00000X
MN65873207RR0500X, 207R00000X
TXU9570207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine