Healthcare Provider Details

I. General information

NPI: 1154383982
Provider Name (Legal Business Name): JAMES JOSEPH NORCONK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SAILFISH RD
VERO BEACH FL
32960-5279
US

IV. Provider business mailing address

601 FRONT AVENUE SUITE #502
COEUR D ALENE ID
83814
US

V. Phone/Fax

Practice location:
  • Phone: 208-415-0524
  • Fax: 208-763-3644
Mailing address:
  • Phone: 208-415-0524
  • Fax: 208-763-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM9157
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: