Provider Demographics
NPI:1346377348
Name:KIRK, GREGORY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:KIRK
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 1:2036 EAST 17TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1106
Mailing Address - Country:US
Mailing Address - Phone:720-334-8328
Mailing Address - Fax:866-897-9458
Practice Address - Street 1:2036 EAST 17TH AVENUE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1106
Practice Address - Country:US
Practice Address - Phone:720-334-8328
Practice Address - Fax:866-897-9458
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO362272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07474865Medicaid
COC503168Medicare PIN
CO07474865Medicaid
COCOA100791Medicare PIN