Provider Demographics
NPI:1548278245
Name:RADERS, JAMES L (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:RADERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1966
Mailing Address - Country:US
Mailing Address - Phone:321-434-8210
Mailing Address - Fax:321-434-8211
Practice Address - Street 1:1421 MALABAR RD NE STE 245
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32907-2586
Practice Address - Country:US
Practice Address - Phone:321-434-8210
Practice Address - Fax:321-434-8211
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN29481207VG0400X
FLME111294207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107501500Medicaid
MN478877000Medicaid
FLMR643OtherFL MEDICARE
FLP02572457OtherFL HF RR MED