Provider Demographics
NPI:1679611750
Name:KIRK, RICHARD F H (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:F H
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 1:395 WEST NAPA STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476
Mailing Address - Country:US
Mailing Address - Phone:707-938-0400
Mailing Address - Fax:707-938-2326
Practice Address - Street 1:395 WEST NAPA STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476
Practice Address - Country:US
Practice Address - Phone:707-938-0400
Practice Address - Fax:707-938-2326
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA023530101Y00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101Y00000XBehavioral Health & Social Service ProvidersCounselor