Provider Demographics
NPI:1710506423
Name:KHARGIE, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KHARGIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33255 STATE ROAD 70 E
Mailing Address - Street 2:
Mailing Address - City:MYAKKA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34251-9725
Mailing Address - Country:US
Mailing Address - Phone:941-421-9784
Mailing Address - Fax:
Practice Address - Street 1:33255 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:MYAKKA CITY
Practice Address - State:FL
Practice Address - Zip Code:34251-9725
Practice Address - Country:US
Practice Address - Phone:941-421-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR624-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR624-P.A.OtherMEDICAL DOCTOR/PHYSICIAN ASSISTANT