Healthcare Provider Details

I. General information

NPI: 1306036868
Provider Name (Legal Business Name): JAMES THOMAS SHOUKAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 01/04/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W COPELAND DR
ORLANDO FL
32806-2101
US

IV. Provider business mailing address

125 W COPELAND DR
ORLANDO FL
32806-2101
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7090
  • Fax: 321-843-2267
Mailing address:
  • Phone: 321-841-7090
  • Fax: 321-843-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number100148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: