Provider Demographics
NPI:1942245774
Name:FLEMING, JOHN F (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:FLEMING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 JOG ROAD
Mailing Address - Street 2:SUITE 107/108
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2164
Mailing Address - Country:US
Mailing Address - Phone:561-742-5959
Mailing Address - Fax:561-734-2226
Practice Address - Street 1:15300 JOG ROAD
Practice Address - Street 2:SUITE 107/108
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2164
Practice Address - Country:US
Practice Address - Phone:561-742-5959
Practice Address - Fax:561-734-2226
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6442Medicare PIN
FLQ57409Medicare UPIN