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General NPI Number Information
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NPI Number | 1962817502
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Entity Type | Individual
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Provider Name | MR. JAMES TICHY
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Gender | Male
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 212 NE 1ST AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3715
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Country | US
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Telephone | 561-808-7581
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Fax | 561-808-7607
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Provider Business Mailing Address
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Address Line | 1730 S FEDERAL HWY #289
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City | DELRAY BEACH
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State | FL
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Zip | 33483-3309
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Country | US
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Telephone | 561-808-7581
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Fax | 561-808-7607
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 1699854562
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License Number State | FL
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