Organization
MOUNTAIN STATE MEDICAL SPECIALTIES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE BRENT KIRKLAND MD (CMO)
(513) 701-5526
Entity
Organization
Contact information
Practice address
120 MEDICAL PARK DR, SUITE 200, BRIDGEPORT, WV 26330-9012
(304) 624-7200
(304) 554-0413
Mailing address
PO BOX 746750, ATLANTA, GA 30374-6750
(866) 680-8505
(937) 436-4156
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RR0500X
Rheumatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810004579
—
WV
Enumeration date
09/20/2006
Last updated
03/14/2025
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