Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 593418264 | FL |
NPI | 1518960780 |
---|---|
Provider Name | Dr. Pamela Kirby |
First Address | Port Orange, FL 32129-7453 |
Second Address | Port Orange, FL 32129-7453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 13/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390329000 | (05) | FL |
593418264 | TAX ID (01) | FL |
U63831 | (02) | FL |