Provider Demographics
NPI:1316197460
Name:JAMES, DESMOND GERALD JR
Entity Type:Individual
Prefix:MR
First Name:DESMOND
Middle Name:GERALD
Last Name:JAMES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17725 STARFISH CT
Mailing Address - Street 2:C
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-6024
Mailing Address - Country:US
Mailing Address - Phone:813-917-4033
Mailing Address - Fax:
Practice Address - Street 1:17725 STARFISH CT
Practice Address - Street 2:C
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-6024
Practice Address - Country:US
Practice Address - Phone:813-917-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20327172V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174400000XOther Service ProvidersSpecialist