Individual
JERRY L KNIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7 GREENWOOD AVE, CONWAY, NH 03818-6130
(603) 447-3500
(603) 447-5568
Mailing address
7 GREENWOOD AVE, CONWAY, NH 03818-6130
(603) 447-3500
(603) 447-5568
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
51343
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014426
NHP
MA
01
—
3314165-002
CIGNA
MA
05
—
6174132
—
MA
01
—
702853
TUFTS
MA
01
—
B141
HPHC
MA
Enumeration date
12/26/2006
Last updated
12/27/2011
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