MEDICARE: JAMES L. AUTIN, M.D.,P.A.

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	207Y00000X	Otolaryngology Physician	ME43580	FL

General Provider Information

NPI Number	:	1922066216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES L. AUTIN, M.D.,P.A.

Provider Business Mailing Address
First Line	:	10377 S US HIGHWAY 1
Second Line	:	STE 101
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5630
Country	:	US
Telephone Number	:	772-337-3700
Fax Number	:	772-335-7820

Provider Business Practice Location Address
First Line	:	10377 S US HIGHWAY 1
Second Line	:	STE 101
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5630
Country	:	US
Telephone Number	:	772-337-3700
Fax Number	:	772-335-7820

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES L AUTIN
Credential	:	M.D.
Telephone Number	:	772-337-3700

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/29/2015

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