Provider Demographics
NPI:1871772202
Name:KIMBROUGH, W B III (MD)
Entity type:Individual
Prefix:DR
First Name:W
Middle Name:B
Last Name:KIMBROUGH
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1014 SAINT CLAIR BLVD
Mailing Address - Street 2:SUITE 3015
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5023
Mailing Address - Country:US
Mailing Address - Phone:225-743-2455
Mailing Address - Fax:225-644-5213
Practice Address - Street 1:1014 SAINT CLAIR BLVD
Practice Address - Street 2:SUITE 3015
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5023
Practice Address - Country:US
Practice Address - Phone:225-743-2455
Practice Address - Fax:225-644-5213
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2021-03-31
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Provider Licenses
StateLicense IDTaxonomies
LAMD202378208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508543Medicaid
LA1508543Medicaid