Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 46060 | CO |
N | 207P00000X | Emergency Physician | AK 7044 | AK |
N | 207RC0200X | Critical Care Medicine | 46060 | CO |
Y | 207RC0200X | Critical Care Medicine | AK 7044 | AK |
NPI | 1033271853 |
---|---|
Provider Name | Dr. James W Cagle JR. |
First Address | Fairbanks, AK 99708-0846 |
Second Address | Fairbanks, AK 99701-5998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 06/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04594040 | (05) | CO |
91356504 | (05) | CO |
K163347 | (05) | AK |