Individual
DR. KIRBY D SOUTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5609 CLAIBORNE RD, SUTHERLAND, VA 23885-9303
(804) 265-5211
(804) 265-2707
Mailing address
5609 CLAIBORNE RD, SUTHERLAND, VA 23885-9303
(804) 265-5211
(804) 265-2707
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101039352
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080642
QUALCHOICE
VA
01
—
100629
ANTHEM
VA
01
—
45882
SENTARA
VA
01
—
5697727
VA. PREMIER
VA
05
—
5697727
—
VA
01
—
577244
AETNA
VA
01
—
815042
SOUTHERN HEALTH
VA
01
—
828665
OPT CHOICE
VA
Enumeration date
03/08/2006
Last updated
02/17/2009
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