Provider Demographics
NPI:1255454336
Name:JAMES G ALEXANDER JR DDS MD PLLC
Entity type:Organization
Organization Name:JAMES G ALEXANDER JR DDS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:870-735-1152
Mailing Address - Street 1:228 W TYLER AVE STE 307
Mailing Address - Street 2:P.O. BOX 907
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72303-0907
Mailing Address - Country:US
Mailing Address - Phone:870-735-1152
Mailing Address - Fax:870-735-4098
Practice Address - Street 1:228 W TYLER AVE
Practice Address - Street 2:STE 307
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4223
Practice Address - Country:US
Practice Address - Phone:870-735-1152
Practice Address - Fax:870-735-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112939001Medicaid
TN4185464Medicaid
AR50999OtherABCBS
AR59309OtherAR M'CARE GROUP PTAN
P00219773OtherRR MEDICARE INDIVIDUAL PTAN
TN4112951OtherTENNESSEE BCBS
DD2979OtherRR MEDICARE GROUP PTAN
AR50999OtherAR M'CARE GROUP MBR PTAN
AR112939001Medicaid
TN4185464Medicaid
AR50999OtherABCBS