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NPI Code Detail

MEDICARE: MR. JAMES WILLIAM PANK PA-C

MEDICARE: MR. JAMES WILLIAM PANK 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
1363AM0700XMedical Physician AssistantPA3860FL

General Provider Information

NPI Number : 1578550216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES WILLIAM PANK PA-C
Provider Business Mailing Address
First Line : 6218 WHIMBRELWOOD DR
Second Line :
City : LITHIA
State : FL
Zip : 33547-4102
Country : US
Telephone Number : 813-760-7176
Fax Number :
Provider Business Practice Location Address
First Line : 220 GRAND REGENCY BLVD
Second Line :
City : BRANDON
State : FL
Zip : 33510-3935
Country : US
Telephone Number : 813-827-9729
Fax Number : 813-827-9706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 07/08/2007

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Directions to “ MR. JAMES WILLIAM PANK PA-C” Practice Location

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