Provider Demographics
NPI:1861447971
Name:KIRK, DONALD J (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:J
Last Name:KIRK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:122 PETERSEN PKWY
Mailing Address - Street 2:STE. 4
Mailing Address - City:THAYNE
Mailing Address - State:WY
Mailing Address - Zip Code:83127
Mailing Address - Country:US
Mailing Address - Phone:307-883-5852
Mailing Address - Fax:307-883-4436
Practice Address - Street 1:122 PETERSEN PKWY
Practice Address - Street 2:STE. 4
Practice Address - City:THAYNE
Practice Address - State:WY
Practice Address - Zip Code:83127
Practice Address - Country:US
Practice Address - Phone:307-883-5852
Practice Address - Fax:307-883-4436
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-04-02
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Provider Licenses
StateLicense IDTaxonomies
WY5720A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYF68853Medicare UPIN