Provider Demographics
NPI:1174659015
Name:KIRBY, JERRY N (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:N
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 AUBURN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-241-2001
Mailing Address - Fax:513-241-2570
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-241-2001
Practice Address - Fax:513-241-2570
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-3017-K174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0572872Medicare PIN
OHA82257Medicare UPIN