Healthcare Provider Details

I. General information

NPI: 1609824978
Provider Name (Legal Business Name): RANDALL PARKER KIRBY M.D., F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 N CENTRAL EXPY, TWR 2 STE 180A
DALLAS TX
75231-0822
US

IV. Provider business mailing address

PO BOX 650759
DALLAS TX
75265-0759
US

V. Phone/Fax

Practice location:
  • Phone: 214-253-0170
  • Fax: 214-253-0171
Mailing address:
  • Phone: 214-253-0170
  • Fax: 214-253-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberH5716
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH5716
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: