Healthcare Provider Details

I. General information

NPI: 1801837646
Provider Name (Legal Business Name): JAMES JOSEPH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 E SHANNON WOODS ST SUITE 100
WICHITA KS
67226-4104
US

IV. Provider business mailing address

10100 E SHANNON WOODS ST SUITE 100
WICHITA KS
67226-4104
US

V. Phone/Fax

Practice location:
  • Phone: 316-219-8299
  • Fax: 316-219-5899
Mailing address:
  • Phone: 316-219-8299
  • Fax: 316-219-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number04-21150
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: