Provider Demographics
NPI:1023467347
Name:JAMES, MARYLIN PALACKEL (DO)
Entity type:Individual
Prefix:
First Name:MARYLIN
Middle Name:PALACKEL
Last Name:JAMES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 STATE RD 13 NORTH
Mailing Address - Street 2:SUITE 106 PMB 157
Mailing Address - City:ST. JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259
Mailing Address - Country:US
Mailing Address - Phone:904-902-0150
Mailing Address - Fax:904-902-7172
Practice Address - Street 1:3000 3RD ST SOUTH SUITE 3004 B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5266
Practice Address - Country:US
Practice Address - Phone:904-902-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine