Provider Demographics
NPI:1124596697
Name:ADCOCK, JAMES PAUL (CAA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PAUL
Last Name:ADCOCK
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18630 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6004
Mailing Address - Country:US
Mailing Address - Phone:305-527-4181
Mailing Address - Fax:
Practice Address - Street 1:1000 36TH ST
Practice Address - Street 2:INDIAN RIVER MEDICAL CENTER
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:305-527-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA480367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant