Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 04-17311 | KS |
NPI | 1013204999 |
---|---|
Provider Name | Dr. Darrel Dean Newkirk |
First Address | Charleston, WV 25313-1156 |
Second Address | Charleston, WV 25313-1156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 09/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F54335 | (02) |