Provider Demographics
NPI:1043349095
Name:DEAGLE, JAMES (PA C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:DEAGLE
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-586-7706
Mailing Address - Fax:508-580-4444
Practice Address - Street 1:909 SUMMER STREET
Practice Address - Street 2:
Practice Address - City:STONGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072
Practice Address - Country:US
Practice Address - Phone:781-297-8261
Practice Address - Fax:508-580-4444
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1537363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P76512Medicare UPIN
AP1866Medicare ID - Type Unspecified