Provider Demographics
NPI:1518981778
Name:JAMES, BRYAN KEITH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:KEITH
Last Name:JAMES
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:621 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1969
Mailing Address - Country:US
Mailing Address - Phone:954-583-9223
Mailing Address - Fax:954-583-9223
Practice Address - Street 1:3702 WASHINGTON ST STE 303
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8287
Practice Address - Country:US
Practice Address - Phone:954-967-6550
Practice Address - Fax:954-967-0912
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant