Provider Demographics
NPI:1902830847
Name:DELOZIER, KIRBY BLAIR (MD)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:BLAIR
Last Name:DELOZIER
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 16988
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77552-6988
Mailing Address - Country:US
Mailing Address - Phone:409-908-9997
Mailing Address - Fax:409-908-0240
Practice Address - Street 1:303 ISLES END RD
Practice Address - Street 2:
Practice Address - City:TIKI ISLAND
Practice Address - State:TX
Practice Address - Zip Code:77554-6147
Practice Address - Country:US
Practice Address - Phone:409-908-9997
Practice Address - Fax:409-908-0240
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD44032085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15176Medicare UPIN