Provider Demographics
NPI:1326081746
Name:KIRKLAND, JOHN ALVIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALVIN
Last Name:KIRKLAND
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 36488
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6488
Mailing Address - Country:US
Mailing Address - Phone:704-248-3400
Mailing Address - Fax:704-337-8387
Practice Address - Street 1:201 QUEENS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3217
Practice Address - Country:US
Practice Address - Phone:704-372-5180
Practice Address - Fax:704-376-6280
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC30559208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340016948OtherINDIVIDUAL RAILROAD MCR#
NC24236OtherPARTNERS PROVIDER #
NC49499OtherBCBS NC INDIVIDUAL #
NC2151656EMedicare ID - Type Unspecified