Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | H0063452 | MD |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 25MB09228900 | NJ |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | N0893 | TX |
NPI | 1316910490 |
---|---|
Provider Name | Dr. Kevin Lee Kirk |
First Address | San Antonio, TX 78212-4803 |
Second Address | San Antonio, TX 78212-4803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 19/11/2014 |