Provider Demographics
NPI:1285682005
Name:AUTIN, JAMES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:AUTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7548 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1450
Mailing Address - Country:US
Mailing Address - Phone:772-466-1091
Mailing Address - Fax:619-415-8099
Practice Address - Street 1:1302 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4806
Practice Address - Country:US
Practice Address - Phone:772-337-3700
Practice Address - Fax:619-415-8099
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43580207Y00000X, 207YS0012X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047112700Medicaid
FL79833ZMedicare PIN
FL047112700Medicaid