Provider Demographics
NPI:1760479513
Name:PINTO, KIRK J (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:J
Last Name:PINTO
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:750 8TH AVE FL 6
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2515
Practice Address - Country:US
Practice Address - Phone:682-303-0376
Practice Address - Fax:682-303-0377
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ02012088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110698102Medicaid
TX110698105OtherMEDICAID OTHER
TX110698103Medicaid
TX110698104Medicaid
TX110698106Medicaid
TX110698102Medicaid
TX110698104Medicaid
TX83Z597Medicare PIN