Provider Demographics
NPI:1760471320
Name:DAVID, KIRBY (PA C)
Entity Type:Individual
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First Name:KIRBY
Middle Name:
Last Name:DAVID
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Gender:M
Credentials:PA C
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Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:SANDERS CLINIC
Mailing Address - City:SANDERS
Mailing Address - State:AZ
Mailing Address - Zip Code:86512-0489
Mailing Address - Country:US
Mailing Address - Phone:928-688-3903
Mailing Address - Fax:928-688-4471
Practice Address - Street 1:NAVAJO BLVD RIO VISTA ESTATE LOT 24
Practice Address - Street 2:SANDERS CLINIC
Practice Address - City:SANDERS
Practice Address - State:AZ
Practice Address - Zip Code:86512
Practice Address - Country:US
Practice Address - Phone:928-688-3903
Practice Address - Fax:928-688-4471
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-03-14
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Provider Licenses
StateLicense IDTaxonomies
AZ3267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant