Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 0102206396 | VA |
N | 208D00000X | General Practice Physician | 0102206396 | VA |
Y | 208D00000X | General Practice Physician | 2675 | WV |
NPI | 1164658118 |
---|---|
Provider Name | Joseph Clary Kirkpatrick |
First Address | Gary, WV 24836-0507 |
Second Address | Gary, WV 24836-0507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2009 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810025232 | (05) | WV |