Provider Demographics
NPI:1902238447
Name:JAMES C PADULA DO INC
Entity Type:Organization
Organization Name:JAMES C PADULA DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-517-0028
Mailing Address - Street 1:3 SW 129TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1779
Mailing Address - Country:US
Mailing Address - Phone:954-517-0027
Mailing Address - Fax:954-517-0029
Practice Address - Street 1:3 SW 129TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1779
Practice Address - Country:US
Practice Address - Phone:954-517-0027
Practice Address - Fax:954-517-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS7318Medicare PIN