Healthcare Provider Details

I. General information

NPI: 1396786976
Provider Name (Legal Business Name): JAMES PICHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST BLDG 2
PHOENIX AZ
85014-5698
US

IV. Provider business mailing address

1510 E FLOWER ST
PHOENIX AZ
85014-5698
US

V. Phone/Fax

Practice location:
  • Phone: 602-287-7000
  • Fax:
Mailing address:
  • Phone: 602-636-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG60730
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number64802
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberG60730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: