Provider Demographics
NPI:1548408347
Name:O'CALLAGHAN, JAMES M (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:O'CALLAGHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:O'CALLAGHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2188 AUTUMN COVE CIR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-3229
Mailing Address - Country:US
Mailing Address - Phone:904-613-0991
Mailing Address - Fax:
Practice Address - Street 1:2188 AUTUMN COVE CIR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-3229
Practice Address - Country:US
Practice Address - Phone:904-613-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2356363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical