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General NPI Number Information
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NPI Number | 1265438147
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Entity Type | Individual
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Provider Name | MR. JAMES O'CONNOR
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Gender | Male
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 7740 NOVA DR SUITE B-4
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City | DAVIE
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State | FL
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Zip | 33324
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Country | US
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Telephone | 954-634-3438
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Fax | 954-634-3437
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Provider Business Mailing Address
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Address Line | 7740 NOVA DR SUITE B-4
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City | DAVIE
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State | FL
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Zip | 33324-5802
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Country | US
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Telephone | 954-634-3438
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Fax | 954-634-3437
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2998
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License Number State | FL
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