Healthcare Provider Details

I. General information

NPI: 1811157035
Provider Name (Legal Business Name): SCOTT KIRBY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 S DOBSON RD
CHANDLER AZ
85224-5605
US

IV. Provider business mailing address

475 S DOBSON RD
CHANDLER AZ
85224-5605
US

V. Phone/Fax

Practice location:
  • Phone: 480-278-3974
  • Fax:
Mailing address:
  • Phone: 480-278-3974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5657
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO 000183
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: