Provider Demographics
NPI:1689736522
Name:AMSBERRY, JAMES KIERAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KIERAN
Last Name:AMSBERRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5565 GROSSMONT CENTER DR BLDG 3 STE 101
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3021
Mailing Address - Country:US
Mailing Address - Phone:619-464-3353
Mailing Address - Fax:619-464-6720
Practice Address - Street 1:5565 GROSSMONT CENTER DR BLDG 3 STE 101
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3021
Practice Address - Country:US
Practice Address - Phone:619-464-3353
Practice Address - Fax:619-464-6720
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG72491207Y00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery