Provider Demographics
NPI:1811911845
Name:JAMES, GINA CRYSTAL (LMT)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:CRYSTAL
Last Name:JAMES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1992
Mailing Address - Country:US
Mailing Address - Phone:503-282-8600
Mailing Address - Fax:503-287-0967
Practice Address - Street 1:2538 NE BROADWAY ST STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1872
Practice Address - Country:US
Practice Address - Phone:503-282-8600
Practice Address - Fax:503-287-0967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7348174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist