Provider Demographics
NPI:1275530099
Name:O'MAILIA, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:O'MAILIA
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 1:15000 SHELL POINT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1657
Mailing Address - Country:US
Mailing Address - Phone:239-542-1464
Mailing Address - Fax:239-454-2111
Practice Address - Street 1:1553 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1734
Practice Address - Country:US
Practice Address - Phone:239-275-3695
Practice Address - Fax:239-275-5402
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2024-04-09
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2007-01-17
Provider Licenses
StateLicense IDTaxonomies
FLME53585174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48751100Medicaid
FLD51901Medicare UPIN
FL48751100Medicaid