Provider Demographics
NPI:1275532772
Name:REPKE, KURT BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:BRYAN
Last Name:REPKE
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 1:1965 COVE LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6426
Mailing Address - Country:US
Mailing Address - Phone:727-736-7873
Mailing Address - Fax:727-736-7905
Practice Address - Street 1:646 VIRGINIA ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6612
Practice Address - Country:US
Practice Address - Phone:727-736-7873
Practice Address - Fax:727-736-7905
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79899207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258386100Medicaid
FL49801GMedicare PIN
FL49801DMedicare PIN
G27455Medicare UPIN
FL49801FMedicare PIN
FL49801EMedicare PIN