Provider Demographics
NPI:1508845454
Name:NORDSTROM, JAMES DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:NORDSTROM
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 1:1200 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-5100
Mailing Address - Fax:515-241-5100
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2400
Practice Address - Fax:515-241-2401
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA20846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0153395Medicaid
IAP01266135OtherRR MEDICARE
IA1153395Medicaid
IA110147576OtherRR MEDICARE
IAA89625Medicare UPIN
IA1153395Medicaid
IAI22140010Medicare PIN