Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | E6118 | TX |
NPI | 1033117155 |
---|---|
Provider Name | Dr. James Frederick Kirk |
First Address | Lubbock, TX 79410-1105 |
Second Address | Lubbock, TX 79410-1326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 27/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116856104 | FIRSTCARE (01) | TX |
132893209 | (05) | TX |
345836YKT8 | MEDICARE (01) | TX |
8EF229 | BCBS (01) | TX |
C17919 | (02) | TX |
U82223 | (05) | NM |