Provider Demographics
NPI:1013959915
Name:JAMES, LINDA K (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:JAMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5403
Mailing Address - Country:US
Mailing Address - Phone:707-961-1234
Mailing Address - Fax:707-961-4786
Practice Address - Street 1:721 RIVER DR
Practice Address - Street 2:SUITE B
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5402
Practice Address - Country:US
Practice Address - Phone:707-961-4631
Practice Address - Fax:707-961-1192
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84834208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G848340Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAG55889Medicare UPIN