Provider Demographics
NPI:1285703009
Name:JAMES D. DAUGHTRY, MD, PA
Entity type:Organization
Organization Name:JAMES D. DAUGHTRY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAUGHTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-746-0541
Mailing Address - Street 1:210 JUPITER LAKES BLVD BLDG 3000
Mailing Address - Street 2:STE 201
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7191
Mailing Address - Country:US
Mailing Address - Phone:561-746-0541
Mailing Address - Fax:561-622-8650
Practice Address - Street 1:210 JUPITER LAKES BLVD BLDG 3000
Practice Address - Street 2:STE 201
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7191
Practice Address - Country:US
Practice Address - Phone:561-746-0541
Practice Address - Fax:561-622-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020583174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57129Medicare UPIN
FLK9288Medicare ID - Type UnspecifiedMEDICARE B GROUP #