Provider Demographics
NPI:1013100866
Name:JAMES, DONALD L (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:JAMES
Suffix:
Gender:M
Credentials:DO
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 579
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65402
Mailing Address - Country:US
Mailing Address - Phone:573-458-3425
Mailing Address - Fax:573-426-2282
Practice Address - Street 1:1050 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401
Practice Address - Country:US
Practice Address - Phone:573-364-7545
Practice Address - Fax:573-368-3672
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1508840901OtherGROUP NPI
MO110046062OtherMEDICARE TRAVLERS ID #
MO10687OtherBLUE SHIELD MO ID #
MO431617399OtherTAX ID #
MO240436139Medicaid
MO110046062OtherMEDICARE TRAVLERS ID #
MO10687OtherBLUE SHIELD MO ID #