Healthcare Provider Details

I. General information

NPI: 1801821558
Provider Name (Legal Business Name): JAMES E DEBOER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W. FAIRCHILD STREET FAMILY MEDICINE/CONVENIENT CARE
DANVILLE IL
61832
US

IV. Provider business mailing address

P.O. BOX 6002
URBANA IL
61803-6002
US

V. Phone/Fax

Practice location:
  • Phone: 217-431-7650
  • Fax: 217-431-7634
Mailing address:
  • Phone: 217-326-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036071275
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: