Provider Demographics
NPI:1013173012
Name:PAGE, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:PAGE
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 1:200 LEE ST
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-2603
Mailing Address - Country:US
Mailing Address - Phone:928-289-3396
Mailing Address - Fax:928-289-2801
Practice Address - Street 1:200 LEE ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-2603
Practice Address - Country:US
Practice Address - Phone:928-289-3396
Practice Address - Fax:928-289-2801
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25792207Q00000X
AZ45775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ45775OtherMEDICAL LICENSE
AZ683667Medicaid
OK25792OtherSTATE LICENSE #