Provider Demographics
NPI:1629274790
Name:MCINTOSH, JAMES FREDERICK JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDERICK
Last Name:MCINTOSH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:23454 DARCY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3924
Mailing Address - Country:US
Mailing Address - Phone:661-255-1773
Mailing Address - Fax:661-255-7237
Practice Address - Street 1:23454 DARCY LN
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-3924
Practice Address - Country:US
Practice Address - Phone:661-255-1773
Practice Address - Fax:661-255-7237
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics