Provider Demographics
NPI:1477691657
Name:KIRT, LON GRANT (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:LON
Middle Name:GRANT
Last Name:KIRT
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:5964 BESTVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4815
Mailing Address - Country:US
Mailing Address - Phone:719-548-9180
Mailing Address - Fax:719-548-9180
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-524-3520
Practice Address - Fax:719-524-3526
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical