Provider Demographics
NPI:1386645844
Name:CARNAHAN, JAMES A
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:CARNAHAN
Suffix:
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 1:3017 WILDERNESS BLVD E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-9332
Mailing Address - Country:US
Mailing Address - Phone:941-776-1145
Mailing Address - Fax:
Practice Address - Street 1:4333 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-2413
Practice Address - Country:US
Practice Address - Phone:941-621-0649
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADOG000Medicare UPIN