Provider Demographics
NPI:1376535732
Name:DUFORT, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:DUFORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14135 CEDAR AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4522
Mailing Address - Country:US
Mailing Address - Phone:952-432-4373
Mailing Address - Fax:952-997-5679
Practice Address - Street 1:14135 CEDAR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4522
Practice Address - Country:US
Practice Address - Phone:952-432-4373
Practice Address - Fax:952-997-5679
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN33987208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF92015Medicare UPIN