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General NPI Number Information
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NPI Number | 1720092943
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Entity Type | Individual
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Provider Name | JAMES WILLIAM VANFOSSEN JR. PA
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 05/13/2024
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Provider Practice Location Address
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Address Line | 160 NW 170TH ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-5576
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Country | US
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Telephone | 305-651-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 800-893-9698
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Fax |
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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 | PA-1273
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601002945
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9118780
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License Number State | FL
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