Provider Demographics
NPI:1902883747
Name:TAKARA, JAMES PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:TAKARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NOKOMIS AVE S STE 207
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 THE RIALTO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2900
Practice Address - Country:US
Practice Address - Phone:941-485-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7574208G00000X
NV23463208G00000X
TXS8498208G00000X
FL154824208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCVD8TXOtherMEDICARE
TX1O3408OtherMEDICARE
TX419863202Medicaid
TX419863201Medicaid
TXP02604468OtherMCRR