MEDICARE: MR. BRYAN KEITH JAMES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9102579	FL

General Provider Information

NPI Number	:	1518981778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN KEITH JAMES PA-C

Provider Business Mailing Address
First Line	:	621 ARIZONA AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-1969
Country	:	US
Telephone Number	:	954-583-9223
Fax Number	:	954-583-9223

Provider Business Practice Location Address
First Line	:	3702 WASHINGTON ST STE 303
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8287
Country	:	US
Telephone Number	:	954-967-6550
Fax Number	:	954-967-0912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/21/2008

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