Provider Demographics
NPI:1083724405
Name:VALES, JAMES STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEVEN
Last Name:VALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VERONICA WAY
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1854
Mailing Address - Country:US
Mailing Address - Phone:309-454-4698
Mailing Address - Fax:
Practice Address - Street 1:109 VERONICA WAY
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1854
Practice Address - Country:US
Practice Address - Phone:309-454-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE18268Medicare ID - Type Unspecified