Healthcare Provider Details

I. General information

NPI: 1972582906
Provider Name (Legal Business Name): CHRIS JOHN KANE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 HERSCHEL ST
JACKSONVILLE FL
32204-3819
US

IV. Provider business mailing address

2165 HERSCHEL ST
JACKSONVILLE FL
32204-3819
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-4030
  • Fax:
Mailing address:
  • Phone: 904-387-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0102201513
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS 10991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: