Healthcare Provider Details

I. General information

NPI: 1740449891
Provider Name (Legal Business Name): JEFFREY SHEPARD KIRK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 CAPITAL MEDICAL BLVD SUITE 200
TALLAHASSEE FL
32308-8417
US

IV. Provider business mailing address

2770 CAPITAL MEDICAL BLVD SUITE 200
TALLAHASSEE FL
32308-8417
US

V. Phone/Fax

Practice location:
  • Phone: 850-402-0202
  • Fax: 850-402-0226
Mailing address:
  • Phone: 850-402-0202
  • Fax: 850-402-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME123252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: