Provider Demographics
NPI:1972898419
Name:VERMEULEN, JAMES M (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:VERMEULEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1425 W H ST STE 380
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3592
Mailing Address - Country:US
Mailing Address - Phone:209-847-0314
Mailing Address - Fax:209-847-4175
Practice Address - Street 1:1425 W H ST STE 380
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3592
Practice Address - Country:US
Practice Address - Phone:209-847-0314
Practice Address - Fax:209-847-4175
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant