Provider Demographics
NPI:1316055395
Name:KIRSNER, RON (MD)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:KIRSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 TAPESTRY PARK CIR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9258
Mailing Address - Country:US
Mailing Address - Phone:904-564-2232
Mailing Address - Fax:904-207-7897
Practice Address - Street 1:9822 TAPESTRY PARK CIR
Practice Address - Street 2:SUITE 206
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9258
Practice Address - Country:US
Practice Address - Phone:904-564-2232
Practice Address - Fax:904-207-7897
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32606Medicare ID - Type Unspecified