Provider Demographics
NPI:1447697388
Name:IRBY, KYLE ANDREW (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
Last Name:IRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 W COMPASS DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0317
Mailing Address - Country:US
Mailing Address - Phone:704-560-2029
Mailing Address - Fax:
Practice Address - Street 1:2800 10TH AVE N
Practice Address - Street 2:EM: EMERGENCY MEDICINE CLINIC
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0703
Practice Address - Country:US
Practice Address - Phone:406-238-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-02
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259635207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program