NPIMap

Organization Active NPI

M.W. Kilgore, II, M.D., P.a.

  • Neurology Physician
  • Jacksonville, FL
National Provider Identifier
1821284589
Registry record updated Nov 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
ME17133 Issued in FL
Legal business name
M.W. KILGORE, II, M.D., P.A.
Practice address
11363 San Jose Blvd
Suite 102
Jacksonville, FL 32223-7957
Phone
(904) 396-2400
Fax
(904) 396-3750
NPI assigned
Sep 17, 2007
Last updated
Nov 4, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Manley W Kilgore IINPI 1114064599
Title
Physician
Phone
(904) 396-2400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X ME17133 FL Primary

Addresses

Primary practice location

11363 San Jose Blvd
Suite 102
Jacksonville, FL 32223-7957

Mailing address

11363 San Jose Blvd
Suite 102
Jacksonville, FL 32223-7957
Phone (904) 396-2400

Other identifiers 1

IdentifierTypeStateIssuer
059854200MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257292800000",
    "number": "1821284589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11363 SAN JOSE BLVD",
            "address_2": "SUITE 102",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322237957",
            "telephone_number": "904-396-2400",
            "fax_number": "904-396-3750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11363 SAN JOSE BLVD",
            "address_2": "SUITE 102",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322237957",
            "telephone_number": "904-396-2400",
            "fax_number": "904-396-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M.W. KILGORE, II, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-17",
        "last_updated": "2009-11-04",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "MANLEY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "904-396-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME17133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "059854200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.