Provider Demographics
NPI:1447404850
Name:JAMES C. COSMIDES, MD, PA
Entity Type:Organization
Organization Name:JAMES C. COSMIDES, MD, PA
Other - Org Name:JAMES C. COSMIDES, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CONSTANTINE
Authorized Official - Last Name:COSMIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-443-2994
Mailing Address - Street 1:427 BILTMORE WAY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5735
Mailing Address - Country:US
Mailing Address - Phone:305-443-2994
Mailing Address - Fax:305-443-9725
Practice Address - Street 1:427 BILTMORE WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5735
Practice Address - Country:US
Practice Address - Phone:305-443-2994
Practice Address - Fax:305-443-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 18064207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D0280182OtherCLIA NUMBER
91707OtherMEDICARE PROVIDER NUMBER
FLFU659AOtherMEDICARE PTAN
FLFU659AOtherMEDICARE PTAN