Provider Demographics
NPI:1760936819
Name:BAVINGER, JAMES CLAYTON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CLAYTON
Last Name:BAVINGER
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 1:3399 PGA BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2831
Mailing Address - Country:US
Mailing Address - Phone:561-624-0099
Mailing Address - Fax:561-624-7373
Practice Address - Street 1:3399 PGA BLVD STE 350
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2831
Practice Address - Country:US
Practice Address - Phone:561-624-0099
Practice Address - Fax:561-624-7373
Is Sole Proprietor?:No
Enumeration Date:2016-08-06
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT390200000X
GA84988207W00000X
FLME153948207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program