Provider Demographics
NPI:1568616977
Name:STURRIDGE, KIRK ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:ALEXANDER
Last Name:STURRIDGE
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 1:5937 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-9317
Mailing Address - Country:US
Mailing Address - Phone:334-446-0872
Mailing Address - Fax:334-446-0893
Practice Address - Street 1:5937 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-9317
Practice Address - Country:US
Practice Address - Phone:334-446-0872
Practice Address - Fax:334-446-0893
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30046207W00000X
IA38353207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80637829AMedicaid
FL002006500Medicaid
AL117610Medicaid
IAI0923237Medicare PIN
AL117610Medicaid
GA80637829AMedicaid
FL002006500Medicaid