Provider Demographics
NPI:1255317178
Name:JAMES, GARY A (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:JAMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1424
Mailing Address - Country:US
Mailing Address - Phone:810-984-2693
Mailing Address - Fax:810-984-2669
Practice Address - Street 1:5312 LAPEER RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1424
Practice Address - Country:US
Practice Address - Phone:810-984-2693
Practice Address - Fax:810-984-2669
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4696657Medicaid
MI4696657Medicaid
MIG74990Medicare UPIN