Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6109 | AZ |
Y | 213EG0000X | General Practice | 6109 | AZ |
NPI | 1003933581 |
---|---|
Provider Name | Dr. James Bourne |
First Address | Chandler, AZ 85225 |
Second Address | Gilbert, AZ 85295-8899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 19/04/2011 |