MEDICARE: KIRBY PLASTIC SURGERY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	N7124	TX

General Provider Information

NPI Number	:	1386937076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRBY PLASTIC SURGERY, PLLC

Provider Business Mailing Address
First Line	:	5075 EDWARDS RANCH RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4133
Country	:	US
Telephone Number	:	817-292-4200
Fax Number	:	817-292-4205

Provider Business Practice Location Address
First Line	:	5075 EDWARDS RANCH RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4133
Country	:	US
Telephone Number	:	817-292-4200
Fax Number	:	817-292-4205

Authorized Official
Title or Position	:	MEMBER, KIRBY PLASTIC SURGERY, PLLC
Name	:	DR. EMILY J KIRBY
Credential	:	MD
Telephone Number	:	817-292-4200

Provider Enumeration Date	:	05/27/2011
Last Update Date	:	10/31/2019

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