Individual
KIMBERLY M WIRTHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
205 S PARK LN, ALTUS, OK 73521-5755
(580) 379-6650
(580) 379-6659
Mailing address
205 S PARK LN, ALTUS, OK 73521-5755
(580) 379-6650
(580) 379-6659
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
04-25854
KS
207Q00000X
Family Medicine Physician
Primary
30873
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100179250 D
—
KS
05
—
100179250C
—
KS
05
—
1619922416
—
MO
05
—
200550380A
—
OK
05
—
203284955
—
MO
Enumeration date
05/23/2006
Last updated
09/03/2014
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