Provider Demographics
NPI:1235107616
Name:FLORACK, JAMES ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ARTHUR
Last Name:FLORACK
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 1:3546 TANGLEBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8502
Mailing Address - Country:US
Mailing Address - Phone:336-413-3121
Mailing Address - Fax:
Practice Address - Street 1:3546 TANGLEBROOK TRL
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8502
Practice Address - Country:US
Practice Address - Phone:336-413-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400491207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900101Medicaid
NC2202448DMedicare ID - Type Unspecified
NC2202448FMedicare PIN
NC5900101Medicaid