Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2019018904 | MO |
NPI | 1184284606 |
---|---|
Provider Name | Benjamin Jay Kirby |
First Address | Columbia, MO 65212-1000 |
Second Address | Columbia, MO 65212-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 17/06/2019 |