Provider Demographics
NPI:1407891013
Name:POITRAS, JAMES KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEVIN
Last Name:POITRAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:2100 VIA BELLA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5429
Practice Address - Country:US
Practice Address - Phone:813-948-1498
Practice Address - Fax:813-355-5040
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88071207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267882900Medicaid
FLP01080504OtherR&R MEDICARE
FL267882900Medicaid