Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 8282 | AL |
NPI | 1992826168 |
---|---|
Provider Name | Dr. Christopher Kirya |
First Address | Gadsden, AL 35902-8467 |
Second Address | Gadsden, AL 35901-5108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51020868KIR | BCBS (01) | AL |
B59495 | (02) |