Provider Demographics
NPI:1114927589
Name:DALEY, JAMES JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JEFFREY
Last Name:DALEY
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:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-0210
Mailing Address - Country:US
Mailing Address - Phone:209-599-4211
Mailing Address - Fax:209-599-7348
Practice Address - Street 1:521 N WILMA AVE STE A
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-9503
Practice Address - Country:US
Practice Address - Phone:209-599-4211
Practice Address - Fax:209-599-7348
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP0024951OtherRAILROAD MEDICARE
CA00A889490Medicaid
CAI30130Medicare UPIN
CA00A889490Medicaid