Provider Demographics
NPI:1740449891
Name:KIRK, JEFFREY SHEPARD (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SHEPARD
Last Name:KIRK
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 1:2770 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8417
Mailing Address - Country:US
Mailing Address - Phone:850-402-0202
Mailing Address - Fax:850-402-0226
Practice Address - Street 1:2770 CAPITAL MEDICAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8417
Practice Address - Country:US
Practice Address - Phone:850-402-0202
Practice Address - Fax:850-402-0226
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015642000Medicaid
FL015642000Medicaid
FLU741YMedicare PIN