Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | ME43580 | FL |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME43580 | FL |
NPI | 1285682005 |
---|---|
Provider Name | James L Autin |
First Address | Port St Lucie, FL 34952-5630 |
Second Address | Port St Lucie, FL 34952-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 10/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
047112700 | (05) | FL |
D58945 | (02) | FL |