Individual
BIRENDRA KC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9 SAN BARTOLA DR, ST AUGUSTINE, FL 32086-5767
(904) 825-4500
(904) 825-3672
Mailing address
7015 A C SKINNER PKWY STE 1, JACKSONVILLE, FL 32256-6932
(904) 363-2113
(904) 363-2606
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2016-00813
NC
207RH0003X
Hematology & Oncology Physician
Primary
ME140216
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102868600
—
FL
01
—
IVC4K
FL BLUE
FL
01
—
LH202
MEDICARE
FL
Enumeration date
07/13/2007
Last updated
10/29/2019
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