Provider Demographics
NPI:1821074980
Name:KIRKPATRICK, RICHARD CHRISTOPHER (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CHRISTOPHER
Last Name:KIRKPATRICK
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 1:1286 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2484
Mailing Address - Country:US
Mailing Address - Phone:321-636-7780
Mailing Address - Fax:321-636-1152
Practice Address - Street 1:1286 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2484
Practice Address - Country:US
Practice Address - Phone:321-636-7780
Practice Address - Fax:321-636-1152
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64220207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70006625OtherRR MEDICARE
FL373770500Medicaid
FL373770500Medicaid
FL70006625OtherRR MEDICARE