Provider Demographics
NPI:1750315842
Name:KIRK, JOEBOB (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEBOB
Middle Name:
Last Name:KIRK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:350
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-252-2800
Mailing Address - Fax:918-252-2888
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:350
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-252-2800
Practice Address - Fax:918-252-2888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3269208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG28248Medicare UPIN