Provider Demographics
NPI:1700251527
Name:BRIAN CHIVAS JAMES MD PA
Entity Type:Organization
Organization Name:BRIAN CHIVAS JAMES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-621-6616
Mailing Address - Street 1:150 W MCKENZIE ST
Mailing Address - Street 2:#114
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5500
Mailing Address - Country:US
Mailing Address - Phone:941-621-6616
Mailing Address - Fax:
Practice Address - Street 1:150 W MCKENZIE ST
Practice Address - Street 2:#114
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5500
Practice Address - Country:US
Practice Address - Phone:941-621-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty