Provider Demographics
NPI:1083696918
Name:KIRBY, DAVID JESSIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JESSIE
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4218 ARENDELL ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2866
Mailing Address - Country:US
Mailing Address - Phone:252-808-3100
Mailing Address - Fax:252-808-3120
Practice Address - Street 1:4218 ARENDELL ST
Practice Address - Street 2:SUITE M
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2866
Practice Address - Country:US
Practice Address - Phone:252-808-3100
Practice Address - Fax:252-808-3120
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2010-00614207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915523Medicaid
NC2076162Medicare PIN