Provider Demographics
NPI:1952339285
Name:THORNTON, JAMES C (MD,FCCP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:C
Last Name:THORNTON
Suffix:
Gender:M
Credentials:MD,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-1982
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1350 HICKORY ST STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-3455
Practice Address - Fax:321-434-3456
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99342208G00000X
OH35.046243208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKH164OtherFL MEDICARE
FL278779200Medicaid
FL278779200Medicaid
FLAF332UMedicare PIN
FL278779200Medicaid
FLAF332YMedicare PIN
FL15426OtherBCBS
FLAF332XMedicare PIN
FLAF332VMedicare PIN