Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 3572 | SD |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 3572 | SD |
NPI | 1154392249 |
---|---|
Provider Name | Kenneth T Kirton JR. |
First Address | Freeman, SD 57029-0900 |
Second Address | Freeman, SD 57029-0900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 09/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5608780 | (05) | SD |
5608782 | (05) | SD |
E56333 | (02) |