Provider Demographics
NPI:1356318042
Name:KIRK, LOUIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:J
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:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:JUDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75660
Mailing Address - Country:US
Mailing Address - Phone:903-663-8756
Mailing Address - Fax:903-663-8765
Practice Address - Street 1:705 E MARSHALL AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5573
Practice Address - Country:US
Practice Address - Phone:903-663-8756
Practice Address - Fax:903-663-8765
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4455207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135661003Medicaid
TX135661005Medicaid
TX8D3976Medicare PIN
TX00JJ94Medicare PIN
TXC17920Medicare UPIN
TX0092BVMedicare PIN
TX87990FMedicare PIN
TX671842Medicare Oscar/Certification
TXOOJJ94Medicare PIN