Provider Demographics
NPI:1770719155
Name:WILLOBEE, JAMES ALTON (CSA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALTON
Last Name:WILLOBEE
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5073 SOUNDSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-8921
Mailing Address - Country:US
Mailing Address - Phone:850-916-2979
Mailing Address - Fax:
Practice Address - Street 1:5073 SOUNDSIDE DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-8921
Practice Address - Country:US
Practice Address - Phone:850-686-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-30
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1059363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical