Individual
MR. GARY JAMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA
Contact information
Practice address
1350 HICKORY ST STE 101, MELBOURNE, FL 32901-3224
(321) 434-1401
(321) 434-1667
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1981
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9110289
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022838200
—
FL
01
—
JE476Y
MEDICARE
FL
01
—
JE476Z
MEDICARE
FL
Enumeration date
05/10/2006
Last updated
01/03/2018
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