Provider Demographics
NPI:1972586725
Name:PAULSON, JAMES B (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:PAULSON
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:IA
Mailing Address - Zip Code:50171-0430
Mailing Address - Country:US
Mailing Address - Phone:641-623-5690
Mailing Address - Fax:641-623-2229
Practice Address - Street 1:101 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:IA
Practice Address - Zip Code:50171
Practice Address - Country:US
Practice Address - Phone:641-623-5690
Practice Address - Fax:641-623-2229
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2044743Medicaid
IAI19638Medicare PIN
IA2044743Medicaid