Provider Demographics
NPI:1184258444
Name:DAILY, JAMES (CPSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DAILY
Suffix:
Gender:M
Credentials:CPSW
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:JAMES
Other - Last Name:DAILY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:614 MCADOO ST STE B
Mailing Address - Street 2:
Mailing Address - City:T OR C
Mailing Address - State:NM
Mailing Address - Zip Code:87901-2706
Mailing Address - Country:US
Mailing Address - Phone:575-297-0171
Mailing Address - Fax:575-894-7383
Practice Address - Street 1:614 MCADOO ST STE B
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-2706
Practice Address - Country:US
Practice Address - Phone:575-297-0171
Practice Address - Fax:575-894-7383
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1018175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist