Provider Demographics
NPI:1922170257
Name:DUVALL, KIRBY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:JAY
Last Name:DUVALL
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 1:1000 E DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1824
Mailing Address - Country:US
Mailing Address - Phone:970-498-3104
Mailing Address - Fax:970-498-3042
Practice Address - Street 1:1000 E DRAKE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1824
Practice Address - Country:US
Practice Address - Phone:970-498-3104
Practice Address - Fax:970-498-3042
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA73189Medicare UPIN