=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730537572
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES GHATTAS DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2016
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 580 VILLAGE BLVD STE 270
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-1951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-822-0543
-----------------------------------------------------
Fax | 954-836-7644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 580 VILLAGE BLVD STE 270
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-1951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-822-0543
-----------------------------------------------------
Fax | 954-836-7644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | THDO00018
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | OS18132
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | OS18132
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------