Provider Demographics
NPI:1215989678
Name:KIRBY, EDWARD EUGENE (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:EUGENE
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 GATEWAY NORTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654
Mailing Address - Country:US
Mailing Address - Phone:830-693-5868
Mailing Address - Fax:830-798-8017
Practice Address - Street 1:204 GATEWAY NORTH
Practice Address - Street 2:SUITE A
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-693-5868
Practice Address - Fax:830-798-8017
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3196207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097888402Medicaid
TX0978884-03Medicaid
TX0555030001Medicare NSC
TXTXB148748Medicare PIN
TX8F22100Medicare PIN
0555030001Medicare PIN
TX00D63HMedicare PIN
E23824Medicare UPIN