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Individual

DR. PAMELA KIRBY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.P.M.

Contact information

Practice address
4606 S CLYDE MORRIS BLVD, STE 1J, PORT ORANGE, FL 32129-7453
(386) 788-4111
(386) 788-4113
Mailing address
4606 S CLYDE MORRIS BLVD, STE 1J, PORT ORANGE, FL 32129-7453
(386) 788-4111
(386) 788-4113

Taxonomy

Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
593418264
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
390329000
FL
01
593418264
TAX ID
FL
Enumeration date
05/23/2005
Last updated
09/13/2012
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