Healthcare Provider Details

I. General information

NPI: 1902858681
Provider Name (Legal Business Name): JAMES T NINOMIYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNM DEPARTMENT OF ORTHOPAEDICS MSC 10-5600 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

UNM DEPARTMENT OF ORTHOPAEDICS MSC 10-5600 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 414-272-1647
  • Fax:
Mailing address:
  • Phone: 414-272-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD2020-0114
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: