Provider Demographics
NPI:1730537572
Name:GHATTAS, JAMES (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GHATTAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 VILLAGE BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1951
Mailing Address - Country:US
Mailing Address - Phone:954-822-0543
Mailing Address - Fax:954-836-7644
Practice Address - Street 1:580 VILLAGE BLVD STE 270
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1951
Practice Address - Country:US
Practice Address - Phone:954-822-0543
Practice Address - Fax:954-836-7644
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTHDO000182084N0400X
FLOS18132208VP0014X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114274800Medicaid