Healthcare Provider Details

I. General information

NPI: 1518327311
Provider Name (Legal Business Name): JOHN KIRK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MARSHALL AVE
LONGVIEW TX
75601-5580
US

IV. Provider business mailing address

PO BOX 3642
LONGVIEW TX
75606-3642
US

V. Phone/Fax

Practice location:
  • Phone: 903-315-2000
  • Fax:
Mailing address:
  • Phone: 903-331-0506
  • Fax: 903-331-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: YASSER ZEID
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 903-315-2700