Healthcare Provider Details

I. General information

NPI: 1639154503
Provider Name (Legal Business Name): MR. JASON EUGENE JAMES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. JASON EUGENE JAMES

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 PUMP RD
RICHMOND VA
23233-1130
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 804-360-8061
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1082443
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003800
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: