Provider Demographics
NPI:1053388728
Name:GO, JAMES T (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3165
Mailing Address - Country:US
Mailing Address - Phone:321-421-7555
Mailing Address - Fax:321-421-7553
Practice Address - Street 1:2290 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3133
Practice Address - Country:US
Practice Address - Phone:321-421-7555
Practice Address - Fax:321-421-7553
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71061207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040014966OtherRAIL ROAD MEDICARE
FL251059600Medicaid
FL251059600Medicaid
040014966OtherRAIL ROAD MEDICARE