Provider Demographics
NPI:1851366207
Name:WALERY, JAMES F (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:WALERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:WALERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NICKNAME
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:34 LAVELLE COURT
Practice Address - Street 2:
Practice Address - City:UNALASKA
Practice Address - State:AK
Practice Address - Zip Code:99685
Practice Address - Country:US
Practice Address - Phone:907-581-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3967207PE0004X, 207Q00000X
AK102832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1636403Medicaid
SD5609880Medicaid
SDF78848Medicare UPIN
AK1636403Medicaid