Provider Demographics
NPI:1801477013
Name:JAMES, TOMMIE LEE III (PA-C)
Entity type:Individual
Prefix:MR
First Name:TOMMIE
Middle Name:LEE
Last Name:JAMES
Suffix:III
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1414 LAUREL AVE APT L211
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1296
Mailing Address - Country:US
Mailing Address - Phone:513-885-9835
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2022-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN13971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant