Provider Demographics
NPI:1164461299
Name:HITCHMAN, JAMES K (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:K
Last Name:HITCHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 KEY COLONY CT
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5654
Mailing Address - Country:US
Mailing Address - Phone:615-957-2756
Mailing Address - Fax:386-788-8777
Practice Address - Street 1:149 KEY COLONY CT
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-5654
Practice Address - Country:US
Practice Address - Phone:615-957-2756
Practice Address - Fax:386-788-8777
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN07852174400000X, 2085R0202X
LA13430208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3193214Medicaid
KYP00790649Medicare PIN
TNB04509Medicare UPIN
KY00151046Medicare PIN
TN3193214Medicaid
KY00280141Medicare PIN
KY00503046Medicare PIN
KY0684441Medicare PIN