Healthcare Provider Details

I. General information

NPI: 1083696918
Provider Name (Legal Business Name): DAVID JESSIE KIRBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 ARENDELL ST SUITE M
MOREHEAD CITY NC
28557-2866
US

IV. Provider business mailing address

4218 ARENDELL ST SUITE M
MOREHEAD CITY NC
28557-2866
US

V. Phone/Fax

Practice location:
  • Phone: 252-808-3100
  • Fax: 252-808-3120
Mailing address:
  • Phone: 252-808-3100
  • Fax: 252-808-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2010-00614
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: