Provider Demographics
NPI:1922066216
Name:JAMES L. AUTIN, M.D.,P.A.
Entity Type:Organization
Organization Name:JAMES L. AUTIN, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:AUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-337-3700
Mailing Address - Street 1:10377 S US HIGHWAY 1
Mailing Address - Street 2:STE 101
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5630
Mailing Address - Country:US
Mailing Address - Phone:772-337-3700
Mailing Address - Fax:772-335-7820
Practice Address - Street 1:10377 S US HIGHWAY 1
Practice Address - Street 2:STE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5630
Practice Address - Country:US
Practice Address - Phone:772-337-3700
Practice Address - Fax:772-335-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43580207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID