Provider Demographics
NPI:1487633160
Name:GAGEN, JAMES SHAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SHAWN
Last Name:GAGEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 361907
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32906-1907
Mailing Address - Country:US
Mailing Address - Phone:321-254-6218
Mailing Address - Fax:321-254-6230
Practice Address - Street 1:1350 S HICKORY STREET
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-254-6218
Practice Address - Fax:321-254-6230
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS011850207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine