Healthcare Provider Details

I. General information

NPI: 1154358828
Provider Name (Legal Business Name): JAMES Y. LEA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 N GOVERNMENT WAY
COEUR D ALENE ID
83814-3541
US

IV. Provider business mailing address

2022 N GOVERNMENT WAY
COEUR D ALENE ID
83814-3541
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-5536
  • Fax: 208-765-1194
Mailing address:
  • Phone: 208-667-5536
  • Fax: 208-765-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberM4476
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: