Provider Demographics
NPI:1609800747
Name:VERWEST, JAMES LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEONARD
Last Name:VERWEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E. CHURCH STREET
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-739-3954
Mailing Address - Fax:805-739-3060
Practice Address - Street 1:340 E BETTERAVIA RD STE C
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7847
Practice Address - Country:US
Practice Address - Phone:805-922-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25003207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A250030OtherBS OF CA
CA00A250030Medicaid
930000975OtherRAILROAD
A25003OtherBC OF CA
A25003OtherCOUNTY OF FRESNO
CA00A250030Medicare PIN
A25003OtherBC OF CA