Provider Demographics
NPI:1902807316
Name:DEFOE, JAMES E (MD P A)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:DEFOE
Suffix:
Gender:M
Credentials:MD P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 SEMINOLE BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-4210
Mailing Address - Country:US
Mailing Address - Phone:727-393-3468
Mailing Address - Fax:727-399-9356
Practice Address - Street 1:10333 SEMINOLE BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-4210
Practice Address - Country:US
Practice Address - Phone:727-393-3468
Practice Address - Fax:727-399-9356
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058275100Medicaid
FL91549ZMedicare PIN
FL058275100Medicaid