Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH9987 | FL |
NPI | 1669790507 |
---|---|
Provider Name | Dr. Roderick Joseph Kirk |
First Address | Palm Bay, FL 32907-1104 |
Second Address | Palm Bay, FL 32907-1104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2010 |
Last Update Date | 07/03/2012 |