Provider Demographics
NPI:1144205287
Name:KENDALL, JAMES EUGENE JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EUGENE
Last Name:KENDALL
Suffix:JR
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 1257
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1257
Mailing Address - Country:US
Mailing Address - Phone:252-823-6333
Mailing Address - Fax:252-823-1406
Practice Address - Street 1:2704 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1918
Practice Address - Country:US
Practice Address - Phone:252-823-6333
Practice Address - Fax:252-823-1406
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500968207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0752276OtherUNITED HEALTH CARE
NC8948374Medicaid
NC2215574AOtherMEDICARE PTAN, INDIVIDUAL
NC64694OtherMEDCOST
NC48374OtherBLUE CROSS BLUE SHIELD
NC48374OtherBLUE CROSS BLUE SHIELD
NC2215574Medicare ID - Type Unspecified