Provider Demographics
NPI:1629147822
Name:VINING, JAMES II (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:VINING
Suffix:II
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 1:2911 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8000
Mailing Address - Country:US
Mailing Address - Phone:928-783-3050
Mailing Address - Fax:928-782-7473
Practice Address - Street 1:2911 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8000
Practice Address - Country:US
Practice Address - Phone:928-783-3050
Practice Address - Fax:928-782-7473
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ229030Medicaid
AZ229030Medicaid
AZWMBKJ03Medicare ID - Type Unspecified