Healthcare Provider Details

I. General information

NPI: 1801484613
Provider Name (Legal Business Name): JAMES DAVID MCCALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W A ST STE 101
MOSCOW ID
83843-6000
US

IV. Provider business mailing address

PO BOX 8007
MOSCOW ID
83843-0507
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-0540
  • Fax: 208-883-1853
Mailing address:
  • Phone: 208-883-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2087
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: