Provider Demographics
NPI:1316910490
Name:KIRK, KEVIN LEE (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:KIRK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1200 BROOKLYN AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4803
Mailing Address - Country:US
Mailing Address - Phone:210-804-5690
Mailing Address - Fax:210-804-5693
Practice Address - Street 1:1200 BROOKLYN AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4803
Practice Address - Country:US
Practice Address - Phone:210-804-5690
Practice Address - Fax:210-804-5693
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2014-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDH0063452207X00000X
TXN0893207XX0004X
NJ25MB09228900207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery