Basic Information
Provider Information | |||||||||
NPI: | 1639461684 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KIRK | ||||||||
FirstName: | FRANCIS | ||||||||
MiddleName: | LOUIS | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: | III | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 462 GRIDER ST | ||||||||
Address2: | DAVID K. MILLER BUILDING | ||||||||
City: | BUFFALO | ||||||||
State: | NY | ||||||||
PostalCode: | 142153021 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7168984226 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 111 COLCHESTER AVENUE | ||||||||
Address2: | WEST PAVILION LEVEL 2 | ||||||||
City: | BURLINGTON | ||||||||
State: | VT | ||||||||
PostalCode: | 05401 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8028472415 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/10/2011 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 042.0013866 | VT | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.