Provider Demographics
NPI:1366419418
Name:FANNING, JAMES (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FANNING
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:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:5016 W CYPRESS ST STE 200A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-530-4592
Practice Address - Fax:813-392-1930
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.005939F207VX0201X
SCTL36735207VX0201X
IN02004699A207VX0201X
FLOS15508207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0974941Medicaid
E64560Medicare UPIN
OHFA0763401Medicare PIN