Provider Demographics
NPI:1114002458
Name:TAKI, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:TAKI
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 1:620 S MAIN ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-4960
Mailing Address - Country:US
Mailing Address - Phone:817-912-8150
Mailing Address - Fax:817-912-8160
Practice Address - Street 1:620 S MAIN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4960
Practice Address - Country:US
Practice Address - Phone:817-912-8150
Practice Address - Fax:817-912-8160
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022057207Q00000X
TXQ0188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016195Medicaid
A 06114Medicare UPIN
WAAB07875Medicare PIN