Provider Demographics
NPI:1588635643
Name:ALI, JAMES LEA (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEA
Last Name:ALI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3306 W ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-3404
Mailing Address - Country:US
Mailing Address - Phone:602-278-4930
Mailing Address - Fax:602-269-7772
Practice Address - Street 1:3306 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3404
Practice Address - Country:US
Practice Address - Phone:602-278-4930
Practice Address - Fax:602-269-7772
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2928363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ912784Medicaid
AZ912784Medicaid