Healthcare Provider Details

I. General information

NPI: 1710506423
Provider Name (Legal Business Name): JAMES KHARGIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33255 STATE ROAD 70 E
MYAKKA CITY FL
34251-9725
US

IV. Provider business mailing address

33255 STATE ROAD 70 E
MYAKKA CITY FL
34251-9725
US

V. Phone/Fax

Practice location:
  • Phone: 941-421-9784
  • Fax:
Mailing address:
  • Phone: 941-421-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number624-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: