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NPI Code Detail

MEDICARE: JAMES STANLEY BOMHARD MD

MEDICARE: JAMES STANLEY BOMHARD MD
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
1207Q00000XFamily Medicine PhysicianME0017796FL
2207QH0002XHospice and Palliative Medicine (Family Medicine) PhysicianME0017796FL
3207Q00000XFamily Medicine PhysicianME17796FL

Other Identifiers

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

General Provider Information

NPI Number : 1336123728
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES STANLEY BOMHARD MD
Provider Business Mailing Address
First Line : 4266 SUNBEAM RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-2425
Country : US
Telephone Number : 904-268-5200
Fax Number :
Provider Business Practice Location Address
First Line : 4266 SUNBEAM RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-2425
Country : US
Telephone Number : 904-268-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 12/05/2018

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