Provider Demographics
NPI:1417925710
Name:SMALL, JAMES MICHAEL (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:SMALL
Suffix:
Gender:M
Credentials:PHD, MD
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Mailing Address - Street 1:103 CONTINENTAL PL
Mailing Address - Street 2:STE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1041
Mailing Address - Country:US
Mailing Address - Phone:615-916-3200
Mailing Address - Fax:615-658-8389
Practice Address - Street 1:6116 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5703
Practice Address - Country:US
Practice Address - Phone:303-512-0888
Practice Address - Fax:303-512-2288
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO29863207ZM0300X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTZ0735Medicaid
CO01298637Medicaid
NM3556Medicaid
AZ641755Medicaid
UTZ0735Medicaid
CO220024547Medicare PIN
AZ641755Medicaid