Provider Demographics
NPI:1467764498
Name:JAMES, TODD MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MICHAEL
Last Name:JAMES
Suffix:
Gender:M
Credentials:DO
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 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-644-4030
Mailing Address - Fax:970-644-3914
Practice Address - Street 1:2373 G RD STE 280
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81505-1006
Practice Address - Country:US
Practice Address - Phone:970-644-4030
Practice Address - Fax:970-644-3914
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7205207RC0000X
CODR.0065812207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ279139Medicaid
AZZ204014OtherMEDICARE