MEDICARE: JAMES FLETCHER

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	103TC0700X	Clinical Psychologist	PY0004753	FL

General Provider Information

NPI Number	:	1326156423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES FLETCHER

Provider Business Mailing Address
First Line	:	482 JACKSONVILLE DR
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3812
Country	:	US
Telephone Number	:	904-247-3600
Fax Number	:	904-247-4926

Provider Business Practice Location Address
First Line	:	482 JACKSONVILLE DR
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3812
Country	:	US
Telephone Number	:	904-247-3600
Fax Number	:	904-247-4926

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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Directions to “ JAMES FLETCHER ” Practice Location

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