Provider Demographics
NPI:1609917947
Name:KILPATRICK, GERALD T (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:T
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 1:22958 DRAKE LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERLAND KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-4313
Mailing Address - Country:US
Mailing Address - Phone:305-745-4391
Mailing Address - Fax:395-745-4391
Practice Address - Street 1:FREE MEDICAL CLINIC
Practice Address - Street 2:144 DUCKWORTH AVE
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712
Practice Address - Country:US
Practice Address - Phone:828-883-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016099208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics