=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811274210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES N ENDICOTT MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2011
-----------------------------------------------------
Last Update Date | 11/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 555 4TH AVE S
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33701-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-551-0800
-----------------------------------------------------
Fax | 727-551-0801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 4TH AVE S
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33701-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-551-0800
-----------------------------------------------------
Fax | 727-551-0801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JAMES N ENDICOTT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-551-0800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME13593
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------