Provider Demographics
NPI:1275591547
Name:JAMES, WILLIAM MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:JAMES
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 1:402 W MORROW RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-6549
Mailing Address - Country:US
Mailing Address - Phone:918-245-1328
Mailing Address - Fax:918-293-3181
Practice Address - Street 1:402 W MORROW RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6549
Practice Address - Country:US
Practice Address - Phone:918-245-1328
Practice Address - Fax:918-293-3181
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3698207R00000X
OK26936208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1275591547Medicaid
AR154267001Medicaid
AR5M870Medicare ID - Type Unspecified
AR154267001Medicaid
OKOK402783Medicare PIN