MEDICARE: DR. THOMAS LLOYD KIRTLEY JR. M.D.

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	207Q00000X	Family Medicine Physician	28768	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710977087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS LLOYD KIRTLEY JR. M.D.

Provider Business Mailing Address
First Line	:	4252 ARENDELL ST
Second Line	:	SUITE A
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-0010
Country	:	US
Telephone Number	:	252-222-0204
Fax Number	:	252-222-0433

Provider Business Practice Location Address
First Line	:	4252 ARENDELL ST
Second Line	:	SUITE A
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-0010
Country	:	US
Telephone Number	:	252-222-0204
Fax Number	:	252-222-0433

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	09/15/2015

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