Healthcare Provider Details

I. General information

NPI: 1376523423
Provider Name (Legal Business Name): JAMES H DEBOE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 NORTH MAIN STREET
HILLSVILLE VA
24343
US

IV. Provider business mailing address

PO BOX 4127
ROANOKE VA
24343
US

V. Phone/Fax

Practice location:
  • Phone: 276-768-4311
  • Fax: 276-728-0901
Mailing address:
  • Phone: 540-981-0283
  • Fax: 540-344-7154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101023220
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: