MEDICARE: GREGORY A KIRK MD

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1629163480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY A KIRK MD

Provider Business Mailing Address
First Line	:	2404 N COURTENAY PKWY
Second Line	:	STE D
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4191
Country	:	US
Telephone Number	:	321-452-4470
Fax Number	:	321-452-4442

Provider Business Practice Location Address
First Line	:	2404 N COURTENAY PKWY
Second Line	:	STE D
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4191
Country	:	US
Telephone Number	:	321-452-4470
Fax Number	:	321-452-4442

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY A KIRK
Credential	:	MD
Telephone Number	:	321-452-4470

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/22/2020

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