MEDICARE: RON KIRSNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0071144	FL

General Provider Information

NPI Number	:	1316055395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RON KIRSNER M.D.

Provider Business Mailing Address
First Line	:	9822 TAPESTRY PARK CIR
Second Line	:	SUITE 206
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9258
Country	:	US
Telephone Number	:	904-564-2232
Fax Number	:	904-207-7897

Provider Business Practice Location Address
First Line	:	9822 TAPESTRY PARK CIR
Second Line	:	SUITE 206
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9258
Country	:	US
Telephone Number	:	904-564-2232
Fax Number	:	904-207-7897

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	02/18/2014

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