1154436129 NPI number — DR. LARRY GENE JAMES D.M.D

Table of content: DR. LARRY GENE JAMES D.M.D (NPI 1154436129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154436129 NPI number — DR. LARRY GENE JAMES D.M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMES
Provider First Name:
LARRY
Provider Middle Name:
GENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154436129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 SOUTH HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33317-0208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-791-6700
Provider Business Mailing Address Fax Number:
954-797-7622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 S HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33317-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-791-6700
Provider Business Practice Location Address Fax Number:
954-797-7622
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN 9512 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005760600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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