Healthcare Provider Details

I. General information

NPI: 1770871527
Provider Name (Legal Business Name): KIRK ANDREW MIDDLETON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 08/15/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 OAKWOOD BLVD
ROUND ROCK TX
78681-4007
US

IV. Provider business mailing address

15808 RANCH ROAD 620 N STE 100
AUSTIN TX
78717-4923
US

V. Phone/Fax

Practice location:
  • Phone: 855-481-8375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number969
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: