Provider Demographics
NPI:1477089928
Name:STRAUB, JAMES KENT (PA- BOARD ELIGIBLE)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KENT
Last Name:STRAUB
Suffix:
Gender:M
Credentials:PA- BOARD ELIGIBLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14909 ORCHARD GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2397
Mailing Address - Country:US
Mailing Address - Phone:804-878-1126
Mailing Address - Fax:804-818-3177
Practice Address - Street 1:14909 ORCHARD GROVE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2397
Practice Address - Country:US
Practice Address - Phone:804-878-1126
Practice Address - Fax:804-818-3177
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant