MEDICARE: LAURA A KIRK PA-C

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	363A00000X	Physician Assistant	103023	NC

General Provider Information

NPI Number	:	1003814989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA A KIRK PA-C

Provider Business Mailing Address
First Line	:	2380 SUTTER ST
Second Line	:	3RD FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3006
Country	:	US
Telephone Number	:	415-613-3625
Fax Number	:	415-613-2603

Provider Business Practice Location Address
First Line	:	2380 SUTTER ST
Second Line	:	3RD FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3006
Country	:	US
Telephone Number	:	415-613-3625
Fax Number	:	415-613-2603

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	06/04/2009

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Directions to “ LAURA A KIRK PA-C” Practice Location

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