| Doctor Name: | MR. LON GRANT KIRT |
| NPI Number: | 1477691657 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHYSICIAN ASSISTANT |
| License Number: | |
| Business Practice Address: | 1650 Cochrane Cir Ft Carson, CO - 809134603 |
| Business Phone Number: | 7195243520 |
| Business Fax Number: | 7195243526 |
| Mailing Address: | 5964 Bestview Way, COLORADO SPRINGS |
| State: | CO |
| Postal Code: | 809184815 |
| Phone Number: | 7195489180 |
| Fax Number: | 7195489180 |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |