Provider Demographics
NPI:1396711057
Name:KURTZ, KEVIN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:KURTZ
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 1:200 HOSPITAL AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9244
Mailing Address - Country:US
Mailing Address - Phone:336-846-7238
Mailing Address - Fax:336-846-2117
Practice Address - Street 1:200 HOSPITAL AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9244
Practice Address - Country:US
Practice Address - Phone:336-846-7238
Practice Address - Fax:336-846-2117
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC895045BMedicaid
NC2168917EMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID NO
NC895045BMedicaid