Healthcare Provider Details

I. General information

NPI: 1013399609
Provider Name (Legal Business Name): JAMES ALEXANDER ISOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

1600 SW ARCHER RD
GAINESVILLE FL
32611-0001
US

V. Phone/Fax

Practice location:
  • Phone: 812-918-3336
  • Fax: 812-918-5887
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01087467A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: