Provider Demographics
NPI:1558347260
Name:NORDAL, JAMES D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:NORDAL
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:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-9667
Mailing Address - Country:US
Mailing Address - Phone:541-592-5099
Mailing Address - Fax:541-592-4636
Practice Address - Street 1:114 W PALMER ST
Practice Address - Street 2:
Practice Address - City:CAVE JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:97523-9667
Practice Address - Country:US
Practice Address - Phone:541-592-5099
Practice Address - Fax:541-592-4636
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061726Medicaid
ORR117526Medicare PIN
OR061726Medicaid
ORR117526Medicare PIN