Basic Information
| Provider Information | |||||||||
| NPI: | 1578769428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | KENNON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 TONGASS DRIVE | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079668423 | ||||||||
| FaxNumber: | 9079668606 | ||||||||
| Practice Location | |||||||||
| Address1: | 3245 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074634040 | ||||||||
| FaxNumber: | 9074634075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 01/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TL-2561 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.