Provider Demographics
NPI:1972533404
Name:JANOUSEK, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:JANOUSEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PINEWOOD WAY SW
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064
Mailing Address - Country:US
Mailing Address - Phone:386-364-4101
Mailing Address - Fax:386-364-5145
Practice Address - Street 1:801 PINEWOOD WAY SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4054
Practice Address - Country:US
Practice Address - Phone:386-364-4101
Practice Address - Fax:386-364-5145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0030682207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02017OtherBLUE CROSS BLUE SHIELD
FL058729000Medicaid
FL100440OtherAVMED
FL100440OtherAVMED
FLD50292Medicare UPIN