Provider Demographics
NPI:1912955402
Name:KIRBY, KARL A (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:A
Last Name:KIRBY
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 1:1250 E 3900 S STE 260
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1371
Mailing Address - Country:US
Mailing Address - Phone:801-265-2000
Mailing Address - Fax:801-506-0296
Practice Address - Street 1:1250 E 3900 S STE 260
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1371
Practice Address - Country:US
Practice Address - Phone:801-265-2000
Practice Address - Fax:801-506-0296
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5242483-1205207Q00000X
HIMD 13016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH100856Medicare PIN
HIH100859Medicare PIN
UT000066671Medicare PIN
HIH100857Medicare PIN
HII42909Medicare UPIN
HIH100858Medicare PIN