Provider Demographics
NPI:1083881247
Name:JAMES, JEREMY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:R
Last Name:JAMES
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 1:76 STARBRUSH CIR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7208
Mailing Address - Country:US
Mailing Address - Phone:985-400-5778
Mailing Address - Fax:985-888-1042
Practice Address - Street 1:76 STARBRUSH CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7208
Practice Address - Country:US
Practice Address - Phone:985-400-5778
Practice Address - Fax:985-888-1042
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203757207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA05868Medicaid