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General NPI Number Information
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NPI Number | 1740286152
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Entity Type | Individual
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Provider Name | WAYNE R KIRKHAM MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 7777 FOREST LN STE C506
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City | DALLAS
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State | TX
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Zip | 75230-6845
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Country | US
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Telephone | 972-566-7515
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Fax | 972-566-7067
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN STE C506
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City | DALLAS
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State | TX
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Zip | 75230-6845
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Country | US
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Telephone | 972-566-7515
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Fax | 972-566-7067
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | E7636
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License Number State | TX
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