Provider Demographics
NPI:1295711760
Name:HART, KIRBY LAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:LAMAR
Last Name:HART
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 1:2431 W MAIN ST
Mailing Address - Street 2:STE 501
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1217
Mailing Address - Country:US
Mailing Address - Phone:334-793-9222
Mailing Address - Fax:334-671-0322
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:STE 501
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1217
Practice Address - Country:US
Practice Address - Phone:334-793-9222
Practice Address - Fax:334-671-0322
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL07069207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
12233OtherCOVENTRY HEALTH CARE
GA00488617AMedicaid
102I168271OtherPTAN
AL511-17846OtherBCBSAL LOCATION ID NUMBER
7410413OtherUNITED HEALTHCARE
7207217OtherCIGNA
FL046793600Medicaid
AL00010721Medicaid
C74807Medicare UPIN
FL046793600Medicaid
7207217OtherCIGNA