Healthcare Provider Details

I. General information

NPI: 1194715177
Provider Name (Legal Business Name): JAMES R DZUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W GEORGIA AVE SUITE 115
NAMPA ID
83686-6811
US

IV. Provider business mailing address

217 W GEORGIA AVE SUITE 115
NAMPA ID
83686-6811
US

V. Phone/Fax

Practice location:
  • Phone: 208-463-3000
  • Fax: 208-463-3034
Mailing address:
  • Phone: 208-463-3000
  • Fax: 208-463-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM5982
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: