Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 32565 | OH |
NPI | 1285691196 |
---|---|
Provider Name | Dr. Thomas E James |
First Address | Warren, OH 44484-2475 |
Second Address | Warren, OH 44484-2475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AJ3101906 | DEA (01) | OH |
B77410 | (02) | OH |