Healthcare Provider Details

I. General information

NPI: 1497954937
Provider Name (Legal Business Name): JOEL A. JAMES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2007
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 INLAND SHORES WAY SUITE 202
KEIZER OR
97303
US

IV. Provider business mailing address

5900 INLAND SHORES WAY SUITE 202
KEIZER OR
97303
US

V. Phone/Fax

Practice location:
  • Phone: 503-463-6799
  • Fax: 503-463-6771
Mailing address:
  • Phone: 503-463-6799
  • Fax: 503-463-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00628
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA00628
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: