Healthcare Provider Details

I. General information

NPI: 1134116817
Provider Name (Legal Business Name): DANIEL LEE KIRBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 JETTON ST STE 115
DAVIDSON NC
28036-0359
US

IV. Provider business mailing address

721 JETTON ST STE 115
DAVIDSON NC
28036-0359
US

V. Phone/Fax

Practice location:
  • Phone: 704-255-6167
  • Fax: 704-255-6168
Mailing address:
  • Phone: 704-255-6167
  • Fax: 704-255-6168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number9900083
License Number StateNC

VII. Legacy identifiers

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

# 1
Identifier891180N
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
IdentifierN00083
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: