Provider Demographics
NPI:1912979147
Name:BAIN, JAMES MASON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MASON
Last Name:BAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:106 19TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3700
Mailing Address - Country:US
Mailing Address - Phone:309-779-7068
Mailing Address - Fax:309-558-7026
Practice Address - Street 1:106 19TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3700
Practice Address - Country:US
Practice Address - Phone:309-779-7068
Practice Address - Fax:309-558-7026
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036105037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105037Medicaid
IL1912979147Medicaid
ILL85917Medicare PIN
IL1912979147Medicaid