Provider Demographics
NPI:1134537384
Name:REPKO, JAMES EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:REPKO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S HABANA AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4161
Mailing Address - Country:US
Mailing Address - Phone:814-943-3668
Mailing Address - Fax:814-942-7635
Practice Address - Street 1:508 S HABANA AVE STE 230
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4161
Practice Address - Country:US
Practice Address - Phone:813-877-6636
Practice Address - Fax:813-877-6610
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2024-10-23
Deactivation Date:2020-07-19
Deactivation Code:
Reactivation Date:2020-07-31
Provider Licenses
StateLicense IDTaxonomies
PASC006712213E00000X
FLPO4191213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103279563001Medicaid