Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 2010-00614 | NC |
NPI | 1083696918 |
---|---|
Provider Name | Dr. David Jessie Kirby |
First Address | Morehead City, NC 28557-2866 |
Second Address | Morehead City, NC 28557-2866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 24/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5915523 | (05) | NC |