Healthcare Provider Details

I. General information

NPI: 1033417985
Provider Name (Legal Business Name): JAMES HOWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 HIGHWAY 179A
WESTVILLE FL
32464-3093
US

IV. Provider business mailing address

PO BOX 121
WESTVILLE FL
32464-0121
US

V. Phone/Fax

Practice location:
  • Phone: 850-982-1293
  • Fax:
Mailing address:
  • Phone: 850-982-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: