Provider Demographics
NPI:1770233660
Name:JAMES, ISAAC DANIEL JR (IDMT)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:DANIEL
Last Name:JAMES
Suffix:JR
Gender:M
Credentials:IDMT
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Other - Credentials:
Mailing Address - Street 1:210 PRALLOW ST UNIT 55331
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-2306
Mailing Address - Country:US
Mailing Address - Phone:661-390-8396
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:661-390-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians