Provider Demographics
NPI:1417979501
Name:KILPATRICK, JEFFERSON KIRBY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:KIRBY
Last Name:KILPATRICK
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 1:5 FIRST VILLAGE DRIVE
Mailing Address - Street 2:PO BOX 2000
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374
Mailing Address - Country:US
Mailing Address - Phone:910-295-6831
Mailing Address - Fax:910-295-0244
Practice Address - Street 1:5 FIRST VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-295-6831
Practice Address - Fax:910-295-0244
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000243207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126AHMedicaid
NCG95852Medicare UPIN
NC2280241Medicare ID - Type Unspecified