Provider Demographics
NPI:1023011129
Name:KIRK, JOHN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:KIRK
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 1:4444 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1142
Mailing Address - Country:US
Mailing Address - Phone:727-328-0900
Mailing Address - Fax:727-327-4272
Practice Address - Street 1:4444 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1142
Practice Address - Country:US
Practice Address - Phone:727-328-0900
Practice Address - Fax:727-327-4272
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068635207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593313537OtherTRICARE
FL27288OtherBCBS PROVIDER NUMBER
FL070008232OtherRAILROAD MEDICARE NUMBER
FL070008232OtherRAILROAD MEDICARE NUMBER
FL27288OtherBCBS PROVIDER NUMBER
FL593313537OtherTRICARE