Active NPI
Gary W Kimzey, MD
- Anesthesiology Physician
- Memphis, TN
National Provider Identifier
1124004072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 11713
- Practice address
- 1265 Union Ave
Memphis, TN 38104-3415 - Phone
- (901) 725-5846
- NPI assigned
- Dec 21, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 11713 | TN | Primary |
Addresses
Primary practice location
1265 Union Ave
Memphis, TN 38104-3415
Mailing address
6060 Primacy Pkwy
Suite 241
Memphis, TN 38119-5745
Phone (901) 725-5846
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0012570 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11713 | TN | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482192000000",
"number": "1124004072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6060 PRIMACY PKWY",
"address_2": "SUITE 241",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381195745",
"telephone_number": "901-725-5846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1265 UNION AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381043415",
"telephone_number": "901-725-5846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMZEY",
"first_name": "GARY",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-21",
"last_updated": "2016-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "TN",
"license": "11713",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0012570",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.