Healthcare Provider Details

I. General information

NPI: 1730537572
Provider Name (Legal Business Name): JAMES GHATTAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 VILLAGE BLVD STE 270
WEST PALM BEACH FL
33409-1951
US

IV. Provider business mailing address

580 VILLAGE BLVD STE 270
WEST PALM BEACH FL
33409-1951
US

V. Phone/Fax

Practice location:
  • Phone: 954-822-0543
  • Fax: 954-836-7644
Mailing address:
  • Phone: 954-822-0543
  • Fax: 954-836-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTHDO00018
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS18132
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS18132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: