Provider Demographics
NPI:1942226527
Name:KIRKDOFFER, DUANE E (DO)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:E
Last Name:KIRKDOFFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 LARIAT TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7827
Mailing Address - Country:US
Mailing Address - Phone:817-548-0222
Mailing Address - Fax:
Practice Address - Street 1:1005 E PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5857
Practice Address - Country:US
Practice Address - Phone:817-548-0222
Practice Address - Fax:817-265-1735
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD OF9101204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD97463Medicare UPIN
888485Medicare ID - Type Unspecified