Provider Demographics
NPI:1982869731
Name:KIRBY, EMILY J (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:J
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:DIKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5075 EDWARDS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4133
Mailing Address - Country:US
Mailing Address - Phone:817-292-4200
Mailing Address - Fax:817-292-4205
Practice Address - Street 1:5075 EDWARDS RANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4133
Practice Address - Country:US
Practice Address - Phone:817-292-4200
Practice Address - Fax:817-292-4205
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7124208200000X
KYR0829390200000X
UT7623934-1205390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program