Provider Demographics
NPI:1598047367
Name:ENNIS, JAMES P II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:ENNIS
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4023 CLOVERLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-2139
Mailing Address - Country:US
Mailing Address - Phone:443-514-5864
Mailing Address - Fax:410-420-9641
Practice Address - Street 1:4023 CLOVERLAND DRIVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-2139
Practice Address - Country:US
Practice Address - Phone:443-514-5864
Practice Address - Fax:410-420-9641
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical