Provider Demographics
NPI:1851626345
Name:KIRK, ROBERT ANDREW (IDC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:KIRK
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 VICTOR WHARF ACCESS ROAD
Mailing Address - Street 2:SEAL DELIVERY VEHICLE TEAM ONE
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3356
Mailing Address - Country:US
Mailing Address - Phone:619-227-7566
Mailing Address - Fax:
Practice Address - Street 1:2001 VICTOR WHARF ACCESS ROAD
Practice Address - Street 2:SEAL DELIVERY VEHICLE TEAM ONE
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3356
Practice Address - Country:US
Practice Address - Phone:619-227-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman