Healthcare Provider Details

I. General information

NPI: 1386645844
Provider Name (Legal Business Name): DR. JAMES A CARNAHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 US HIGHWAY 301 N
ELLENTON FL
34222-2413
US

IV. Provider business mailing address

3017 WILDERNESS BLVD E
PARRISH FL
34219-9332
US

V. Phone/Fax

Practice location:
  • Phone: 941-621-0649
  • Fax:
Mailing address:
  • Phone: 941-776-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME52978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: