Basic Information
| Provider Information | |||||||||
| NPI: | 1518327311 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN KIRK MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3642 | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756063642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033310506 | ||||||||
| FaxNumber: | 9033310462 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E MARSHALL AVE | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756015580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033152000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2016 | ||||||||
| LastUpdateDate: | 03/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | ZEID | ||||||||
| AuthorizedOfficialFirstName: | YASSER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 9033152700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.