Provider Demographics
NPI:1972604908
Name:KIRKLEY, SCOTT DAVID (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:KIRKLEY
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:PO BOX 957683
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-1921
Mailing Address - Country:US
Mailing Address - Phone:573-756-6751
Mailing Address - Fax:573-760-8044
Practice Address - Street 1:1106 HAZEL LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1999
Practice Address - Country:US
Practice Address - Phone:573-756-6751
Practice Address - Fax:573-760-8044
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007007776208M00000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207019803Medicaid
MO207019803Medicaid