Provider Demographics
NPI:1083893267
Name:KIRTON, ROBERT B (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:KIRTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E REYNOLDS DR
Mailing Address - Street 2:D
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2804
Mailing Address - Country:US
Mailing Address - Phone:318-255-3234
Mailing Address - Fax:
Practice Address - Street 1:105 E REYNOLDS DR
Practice Address - Street 2:D
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2804
Practice Address - Country:US
Practice Address - Phone:318-255-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD162R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1657212Medicaid
LA5W048Medicare PIN