10D2120825 CLIA NUMBER - JOHN M KILGORE MD

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Laboratory Demographics

CLIA Number: 10D2120825

Facility Name: JOHN M KILGORE MD

Facility Address:
122 S MOON AVE
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 502-6430

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518140128

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	10D2120825
LAB Type	Physician Office
Facility Name	JOHN M KILGORE MD
Street	122 S MOON AVE
City	BRANDON
State	FL
ZIP	33511
Phone	813 502-6430
CertificateType	4
CertificateEffectiveDate	10/25/2022
CertificateExpirationDate	10/24/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024