Provider Demographics
NPI:1306882980
Name:KIRK, CLINT FORREST (DO)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:FORREST
Last Name:KIRK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502
Mailing Address - Country:US
Mailing Address - Phone:580-357-9984
Mailing Address - Fax:580-357-3277
Practice Address - Street 1:110 NW 31ST 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-357-3671
Practice Address - Fax:580-357-1256
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3331207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5433409OtherFIRST HEALTH CCN
OK731612928OtherPPO OK
OKP00007143OtherRR MEDICARE
OK8608608002OtherCIGNA PPO
OK731612928OtherCOMPCHOICE
OK100169700BMedicaid
OK5433409OtherMAIL HANDLERS
OK2012060OtherFIRST HEALTH
OK731612928OtherBLUELINCS
OK731612928001OtherBC/BS
OK731612928OtherBLUELINCS
OK80052228Medicare ID - Type Unspecified