MEDICARE: RANDALL PARKER KIRBY M.D., F.A.C.S.

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	208600000X	Surgery Physician	H5716	TX
2	2086S0129X	Vascular Surgery Physician	H5716	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0015JL	OTHER	TX	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	H5716	OTHER	TX	TX STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1609824978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL PARKER KIRBY M.D., F.A.C.S.

Provider Business Mailing Address
First Line	:	PO BOX 650759
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0759
Country	:	US
Telephone Number	:	214-253-0170
Fax Number	:	214-253-0171

Provider Business Practice Location Address
First Line	:	8140 WALNUT HILL LN STE 800
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4396
Country	:	US
Telephone Number	:	214-253-0170
Fax Number	:	214-253-0171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	02/03/2026

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