Provider Demographics
NPI:1881709905
Name:CANTERBURY, JAMES L (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:CANTERBURY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:614-702-7655
Mailing Address - Fax:
Practice Address - Street 1:5156 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2424
Practice Address - Country:US
Practice Address - Phone:614-702-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2825-C213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1881709905Medicaid
IN201326650Medicaid
OH0938347Medicaid
WIP01458521OtherRAILROAD MEDICARE
INP01555868OtherRAILROAD MEDICARE
OH0938347Medicaid
WI1881709905Medicaid
IN201326650Medicaid
OH4928110001Medicare NSC
IN859800003Medicare PIN