Provider Demographics
NPI:1174505499
Name:JOHNS, JAMES CLYDE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLYDE
Last Name:JOHNS
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 1:1953 1ST AVE SE, STE C4
Mailing Address - Street 2:CEDAR VALLEY HAND SURGERY, PLC
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5328
Mailing Address - Country:US
Mailing Address - Phone:319-364-2697
Mailing Address - Fax:
Practice Address - Street 1:1953 1ST AVE SE, STE C4
Practice Address - Street 2:CEDAR VALLEY HAND SURGERY, PLC
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5328
Practice Address - Country:US
Practice Address - Phone:319-364-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24119207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3072694Medicaid
IA17027OtherBLUE CROSS/BLUE SHIELD
IA1183500001Medicare NSC
IA17027OtherBLUE CROSS/BLUE SHIELD
IA3072694Medicaid