Provider Demographics
NPI:1124215199
Name:JOHN F KIRK MD, PA
Entity Type:Organization
Organization Name:JOHN F KIRK MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-328-0900
Mailing Address - Street 1:4444 CENTRAL AVE
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 AVE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068635207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK3589OtherPALMETTO GBA RAILROAD MEDICARE
CK3589OtherPALMETTO GBA RAILROAD MEDICARE