Healthcare Provider Details

I. General information

NPI: 1093761959
Provider Name (Legal Business Name): JAMES MCNAMARA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

1 ORTHOPAEDIC PL
ST AUGUSTINE FL
32086-4202
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-4700
  • Fax: 800-536-8431
Mailing address:
  • Phone: 904-825-0540
  • Fax: 904-825-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA1762
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: