Provider Demographics
NPI:1366407348
Name:MCMULLAN, JAMES L III (PAC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:MCMULLAN
Suffix:III
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:930 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-725-5050
Mailing Address - Fax:321-725-9100
Practice Address - Street 1:8057 SPYGLASS HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8565
Practice Address - Country:US
Practice Address - Phone:321-435-3500
Practice Address - Fax:321-435-3501
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290844100Medicaid
FLE3406AMedicare ID - Type Unspecified
FL290844100Medicaid