MEDICARE: JAMES WILLIAM FITCH PA-C

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	363AM0700X	Medical Physician Assistant	PA3329	FL

General Provider Information

NPI Number	:	1912913633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WILLIAM FITCH PA-C

Provider Business Mailing Address
First Line	:	854 W PLYMOUTH AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3284
Country	:	US
Telephone Number	:	386-736-3401
Fax Number	:	386-734-2935

Provider Business Practice Location Address
First Line	:	854 W PLYMOUTH AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3284
Country	:	US
Telephone Number	:	386-736-3401
Fax Number	:	386-734-2935

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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