Provider Demographics
NPI:1124022652
Name:KIRBY, SAMUEL CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CRAIG
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:404 WESTWOOD AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4316
Mailing Address - Country:US
Mailing Address - Phone:336-887-3195
Mailing Address - Fax:336-887-3194
Practice Address - Street 1:404 WESTWOOD AVE
Practice Address - Street 2:STE 107
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4316
Practice Address - Country:US
Practice Address - Phone:336-887-3195
Practice Address - Fax:336-887-3194
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC30188207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8949386Medicaid
NC207886Medicare ID - Type Unspecified
NC8949386Medicaid