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General NPI Number Information
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NPI Number | 1922163476
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Entity Type | Individual
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Provider Name | JERRY L KNIRK MD
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 7 GREENWOOD AVE
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City | CONWAY
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State | NH
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Zip | 03818-6130
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Country | US
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Telephone | 603-447-3500
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Fax | 603-447-5568
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Provider Business Mailing Address
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Address Line | 7 GREENWOOD AVE
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City | CONWAY
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State | NH
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Zip | 03818-6130
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Country | US
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Telephone | 603-447-3500
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Fax | 603-447-5568
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 51343
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License Number State | MA
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