Healthcare Provider Details

I. General information

NPI: 1215951447
Provider Name (Legal Business Name): DAVID P KIRCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W OTTLEY AVE
FRUITA CO
81521-2118
US

IV. Provider business mailing address

300 W OTTLEY AVE
FRUITA CO
81521-2118
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-3900
  • Fax: 970-858-2202
Mailing address:
  • Phone: 970-858-3900
  • Fax: 970-858-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0420008113
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0046243
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: