Provider Demographics
NPI:1265438147
Name:O'CONNOR, JAMES
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:O'CONNOR
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 1:7740 NOVA DR
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5802
Mailing Address - Country:US
Mailing Address - Phone:954-634-3438
Mailing Address - Fax:954-634-3437
Practice Address - Street 1:7740 NOVA DR
Practice Address - Street 2:SUITE B-4
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-634-3438
Practice Address - Fax:954-634-3437
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0468RMedicare ID - Type Unspecified