Provider Demographics
NPI:1922108646
Name:JAMES, FRED M (DPM)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:M
Last Name:JAMES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N COTNER BLVD
Mailing Address - Street 2:SUIT 116
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-466-6677
Mailing Address - Fax:402-466-6624
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:SUIT 116
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-466-6677
Practice Address - Fax:402-466-6624
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE185213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1840OtherMIDLANDS CHOICE
NE02510OtherLINCOLN
NE02595OtherBEATRICE
NE47074663300Medicaid
KS114095OtherBEATRICE
NE47074663301Medicaid
NE1104170001Medicare ID - Type UnspecifiedCIGNA MEDICARE
NE02510OtherLINCOLN
NE261716Medicare ID - Type UnspecifiedBEATRICE
NE47074663301Medicaid
NET40107Medicare UPIN