Provider Demographics
NPI:1013988997
Name:JAMES, JON (DPM)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:DPM
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 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-877-8330
Mailing Address - Fax:702-870-9876
Practice Address - Street 1:2316 W CHARLESTON
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-877-8330
Practice Address - Fax:702-870-9876
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8902213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1013988997Medicaid
NV2102794Medicaid
T66697Medicare UPIN
NV1013988997Medicaid