Provider Demographics
NPI:1316979768
Name:BIERIG, KIRT EUGENE (DO)
Entity type:Individual
Prefix:DR
First Name:KIRT
Middle Name:EUGENE
Last Name:BIERIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:OKEENE
Mailing Address - State:OK
Mailing Address - Zip Code:73763-0389
Mailing Address - Country:US
Mailing Address - Phone:580-822-4404
Mailing Address - Fax:580-822-4403
Practice Address - Street 1:124 N 6TH ST
Practice Address - Street 2:
Practice Address - City:OKEENE
Practice Address - State:OK
Practice Address - Zip Code:73763-9135
Practice Address - Country:US
Practice Address - Phone:580-822-4404
Practice Address - Fax:580-822-4403
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700250DMedicaid
OK100094160 BMedicaid
OK100736170 AMedicaid
OK395086ZL9ZMedicare PIN
OK100700250DMedicaid