Provider Demographics
NPI:1760450092
Name:COONEY, JAMES JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JASON
Last Name:COONEY
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 1:300 LA VIDA DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3320
Mailing Address - Country:US
Mailing Address - Phone:602-540-3744
Mailing Address - Fax:
Practice Address - Street 1:975 S FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5118
Practice Address - Country:US
Practice Address - Phone:602-540-3744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256511207L00000X, 207LC0200X
CAA79878207L00000X
VA010125611207L00000X, 207LC0200X
ORMD26428207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA129451Medicare UPIN
CA00A79878Medicaid
AZ326741Medicaid
AZZ121699Medicare PIN
P0071996OtherMEDICARE RAILROAD