MEDICARE: MR. JAMES O'CONNOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA2998	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265438147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES O'CONNOR

Provider Business Mailing Address
First Line	:	7740 NOVA DR
Second Line	:	SUITE B-4
City	:	DAVIE
State	:	FL
Zip	:	33324-5802
Country	:	US
Telephone Number	:	954-634-3438
Fax Number	:	954-634-3437

Provider Business Practice Location Address
First Line	:	7740 NOVA DR
Second Line	:	SUITE B-4
City	:	DAVIE
State	:	FL
Zip	:	33324
Country	:	US
Telephone Number	:	954-634-3438
Fax Number	:	954-634-3437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/04/2021

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