Provider Demographics
NPI:1639140163
Name:ROUNDER, JAMES BURNELL JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BURNELL
Last Name:ROUNDER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3329
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895
Mailing Address - Country:US
Mailing Address - Phone:252-243-5511
Mailing Address - Fax:252-399-7575
Practice Address - Street 1:2509 WOOTEN BLVD SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27895
Practice Address - Country:US
Practice Address - Phone:252-243-5511
Practice Address - Fax:252-399-7575
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7973448Medicaid
B65500Medicare UPIN
NC7973448Medicaid