Basic Information
Provider Information
NPI: 1003802497
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JAMES
FirstName: DAVID
MiddleName: E
NamePrefix: MR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4863B SCOTTSVILLE RD
Address2:  
City: BOWLING GREEN
State: KY
PostalCode: 421047855
CountryCode: US
TelephoneNumber: 2708435662
FaxNumber: 2708435614
Practice Location
Address1: 4863B SCOTTSVILLE RD
Address2:  
City: BOWLING GREEN
State: KY
PostalCode: 421047855
CountryCode: US
TelephoneNumber: 2708435662
FaxNumber: 2708435614
Other Information
ProviderEnumerationDate: 09/21/2005
LastUpdateDate: 03/03/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X36431KYY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
6403757505KY MEDICAID


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