Basic Information
| Provider Information | |||||||||
| NPI: | 1376504118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IGLEBURGER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 890 SOUTH PARK PALAFOX STREET | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504331656 | ||||||||
| FaxNumber: | 8504331996 | ||||||||
| Practice Location | |||||||||
| Address1: | 890 SOUTH PARK PALAFOX STREET | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504331656 | ||||||||
| FaxNumber: | 8504331996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 12/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME 94223 | FL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | ME94223 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | ME 94223 | 01 | FL | MEDICAL LICENSE | OTHER |