Provider Demographics
NPI:1932184629
Name:LI, JAMES Y (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:Y
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:612 N WASHINGTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4436
Mailing Address - Country:US
Mailing Address - Phone:432-332-9263
Mailing Address - Fax:432-332-9264
Practice Address - Street 1:612 N WASHINGTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4436
Practice Address - Country:US
Practice Address - Phone:432-332-9263
Practice Address - Fax:432-332-9264
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2417208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145927303Medicaid
TX8F0997Medicare PIN
TX145927303Medicaid