Provider Demographics
NPI:1467431213
Name:PAUL, JAMES F (DDS, MS, MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:PAUL
Suffix:
Gender:M
Credentials:DDS, MS, MD
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Mailing Address - Street 1:3385 DEXTER CT
Mailing Address - Street 2:SUITE 115
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3461
Mailing Address - Country:US
Mailing Address - Phone:563-359-4777
Mailing Address - Fax:563-359-4781
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:SUITE 115
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3461
Practice Address - Country:US
Practice Address - Phone:563-359-4777
Practice Address - Fax:563-359-4781
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2015-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA33897174400000X, 204E00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104275Medicaid
IA0244574Medicaid
IAH38754Medicare UPIN
IA0244574Medicaid