Provider Demographics
NPI:1023207552
Name:JAMES D NORDAL
Entity Type:Organization
Organization Name:JAMES D NORDAL
Other - Org Name:CAVE JUNCTION FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:NORDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-592-5099
Mailing Address - Street 1:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-9667
Mailing Address - Country:US
Mailing Address - Phone:541-592-5099
Mailing Address - Fax:541-592-4636
Practice Address - Street 1:114 W PALMER ST
Practice Address - Street 2:
Practice Address - City:CAVE JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:97523-9667
Practice Address - Country:US
Practice Address - Phone:541-592-5099
Practice Address - Fax:541-592-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR117524Medicare PIN