Provider Demographics
NPI:1801885702
Name:NORTHERN, JAMES R (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:NORTHERN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:201 E MONROE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2852
Mailing Address - Country:US
Mailing Address - Phone:573-581-5850
Mailing Address - Fax:573-581-8185
Practice Address - Street 1:620 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2919
Practice Address - Country:US
Practice Address - Phone:573-581-5850
Practice Address - Fax:573-581-8185
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2010-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR8A002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243605805Medicaid
MO300044909OtherMEDICARE RAILROAD
MOF31472Medicare UPIN
MO243605805Medicaid