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General NPI Number Information
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NPI Number | 1174864060
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Entity Type | Organization
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Legal Business Name | JOHN KIRK MD
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Dates
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Enumeration Date | 03/03/2013
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 705 E MARSHALL AVE SUITE 3000
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City | LONGVIEW
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State | TX
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Zip | 75601-5573
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Country | US
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Telephone | 903-315-2700
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Fax | 903-663-8765
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Provider Business Mailing Address
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Address Line | PO BOX 626
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City | JUDSON
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State | TX
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Zip | 75660-0626
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Country | US
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Telephone | 903-663-8756
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Fax | 903-663-8765
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELLE J TRICH
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Credential |
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Telephone | 903-663-8756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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