Provider Demographics
NPI:1255341996
Name:THRESS, JAMES R (PA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:THRESS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1921 WALDEMERE ST STE 310
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2941
Practice Address - Country:US
Practice Address - Phone:941-917-5400
Practice Address - Fax:941-917-5420
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002063363AS0400X
FLPA9106000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ33289Medicare UPIN
FLEZ456ZMedicare PIN
VA008486S26Medicare ID - Type Unspecified
FL003982300Medicaid