Provider Demographics
NPI:1013956697
Name:KIRBY, DALE SCOTT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:SCOTT
Last Name:KIRBY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:SCOTT
Other - Last Name:KIRBY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D-330
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-607-9797
Mailing Address - Fax:251-607-9761
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D-330
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-607-9797
Practice Address - Fax:251-607-9761
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019224207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-05419OtherBLUE CROSS BLUE SHIELD
MS0125474Medicaid
AL051505419Medicaid
AL051505419Medicaid
ALG29887Medicare UPIN