Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | ME-71437 | FL |
N | 208200000X | Surgeon | ME0071437 | FL |
N | 208600000X | Surgeon | ME0071437 | FL |
N | 2086S0102X | Surgical Critical Care | ME-71437 | FL |
N | 208G00000X | Cardiothoracic Vascular Surgeon | ME0071437 | FL |
NPI | 1083683353 |
---|---|
Provider Name | Dr. James K. Condon |
First Address | New Port Richey, FL 34653-4935 |
Second Address | New Port Richey, FL 34653-4935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 11/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
252311600 | (05) | FL |
32303U | MEDICARE PTAN (01) | FL |
B82097 | (02) | FL |