Provider Demographics
NPI:1447393244
Name:KEARNEY, JAMES DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:KEARNEY
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 1:580 N WICKHAM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8400
Mailing Address - Country:US
Mailing Address - Phone:321-255-7118
Mailing Address - Fax:321-255-8391
Practice Address - Street 1:580 N WICKHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8400
Practice Address - Country:US
Practice Address - Phone:321-255-7118
Practice Address - Fax:321-255-8391
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC31805Medicare UPIN
FL02223BMedicare ID - Type Unspecified