Healthcare Provider Details

I. General information

NPI: 1194701359
Provider Name (Legal Business Name): JAMES LEROY SPRINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 FOXBOROUGH RUN
SHELBYVILLE IN
46176
US

IV. Provider business mailing address

104 FOXBOROUGH RUN
SHELBYVILLE IN
46176-2879
US

V. Phone/Fax

Practice location:
  • Phone: 317-512-2711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17476
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01065737A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: