Healthcare Provider Details

I. General information

NPI: 1215964986
Provider Name (Legal Business Name): JAMES D. GLOOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 TEN ROD ROAD UNIT B-2/10
NORTH KINGSTOWN RI
02852
US

IV. Provider business mailing address

1051 TEN ROD ROAD UNIT B-2/10
NORTH KINGSTOWN RI
02852
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-8200
  • Fax: 401-294-8222
Mailing address:
  • Phone: 401-294-8200
  • Fax: 401-294-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD05692
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: