Provider Demographics
NPI:1962678250
Name:KIRKLAND, BRIAN W
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:KIRKLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:KIRKLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9901 BRADFORD PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-2150
Mailing Address - Country:US
Mailing Address - Phone:505-891-3346
Mailing Address - Fax:505-994-4977
Practice Address - Street 1:9901 BRADFORD PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-2150
Practice Address - Country:US
Practice Address - Phone:505-891-3346
Practice Address - Fax:505-994-4977
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMFA0055242332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies