Provider Demographics
NPI:1922020783
Name:KIRK, JOHN HOWARTH III (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HOWARTH
Last Name:KIRK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-0228
Mailing Address - Country:US
Mailing Address - Phone:707-967-7550
Mailing Address - Fax:707-963-5083
Practice Address - Street 1:821 SAINT HELENA HWY S
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-2266
Practice Address - Country:US
Practice Address - Phone:707-967-7550
Practice Address - Fax:707-963-5083
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54807207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0081501OtherMEDI-CAL
CAGR0081500Medicaid
G73409Medicare UPIN
CAGR0081500Medicaid