Provider Demographics
NPI:1811069214
Name:JAMES W MCCONNELL MD PA
Entity type:Organization
Organization Name:JAMES W MCCONNELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-283-0226
Mailing Address - Street 1:410 SE HIBISCUS AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-2550
Mailing Address - Country:US
Mailing Address - Phone:772-283-0226
Mailing Address - Fax:772-283-0480
Practice Address - Street 1:410 SE HIBISCUS AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-2550
Practice Address - Country:US
Practice Address - Phone:772-283-0226
Practice Address - Fax:772-283-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54828Medicare UPIN
FL43034Medicare ID - Type Unspecified