Healthcare Provider Details

I. General information

NPI: 1437726064
Provider Name (Legal Business Name): NOAH JORDAN KAINRAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 12/18/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG AS4021 CANAL STREET
JACKSONVILLE NC
28540
US

IV. Provider business mailing address

220 HOVEY RD
PENSACOLA FL
32508-1044
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-2960
  • Fax:
Mailing address:
  • Phone: 850-452-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberOS19186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: