Provider Demographics
NPI:1407114911
Name:GUERRIERE, JAMES DANIEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:GUERRIERE
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 1:24 FALCON CREST LN
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-6620
Mailing Address - Country:US
Mailing Address - Phone:828-452-8878
Mailing Address - Fax:828-452-8879
Practice Address - Street 1:24 FALCON CREST LN
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-6620
Practice Address - Country:US
Practice Address - Phone:828-452-8878
Practice Address - Fax:828-452-8879
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL3745R208000000X
NC2015-01492208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1407114911Medicaid