Provider Demographics
NPI:1215138003
Name:CERONE, JAMES MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:CERONE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1160
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77497-1160
Mailing Address - Country:US
Mailing Address - Phone:917-939-9737
Mailing Address - Fax:
Practice Address - Street 1:4200 SCOTLAND ST
Practice Address - Street 2:#310
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-7325
Practice Address - Country:US
Practice Address - Phone:917-939-9737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06288TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216177001Medicaid
TXTXB101247Medicare PIN