Basic Information
| Provider Information | |||||||||
| NPI: | 1821232471 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES F. MCNAB MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 864541 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328864541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125830205 | ||||||||
| FaxNumber: | 5125832002 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 RIBAUT RD | ||||||||
| Address2: | STE A | ||||||||
| City: | PORT ROYAL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299352008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435227800 | ||||||||
| FaxNumber: | 8435240378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2009 | ||||||||
| LastUpdateDate: | 09/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | MCNAB | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8435227800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | MD29369 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 293694 | 05 | SC | MEDICAID |