Provider Demographics
NPI:1942993670
Name:FLYTHE, JAMES RYLAND
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RYLAND
Last Name:FLYTHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 DEER LAKE DR E STE 4114
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6320
Mailing Address - Country:US
Mailing Address - Phone:252-678-2127
Mailing Address - Fax:
Practice Address - Street 1:4870 DEER LAKE DR E STE 4114
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6320
Practice Address - Country:US
Practice Address - Phone:252-678-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant