Provider Demographics
NPI:1316030984
Name:UNDERWOOD, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:UNDERWOOD
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 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-888-7721
Practice Address - Street 1:9853 PACIFIC HEIGHTS BLVD
Practice Address - Street 2:STE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4721
Practice Address - Country:US
Practice Address - Phone:858-888-7700
Practice Address - Fax:858-888-7721
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42722207ZP0102X
IN01033259A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A427220Medicaid
CAFB470ZOtherMEDICARE PTAN-GENESIS HEALTHCARE PARTNERS
CAWA42722BMedicare PIN
CAFB470ZOtherMEDICARE PTAN-GENESIS HEALTHCARE PARTNERS
CAE32617Medicare UPIN
CA220015883Medicare PIN