Healthcare Provider Details

I. General information

NPI: 1740619949
Provider Name (Legal Business Name): JAMES ORVAL WAGES JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 03/18/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040A JACKSON AVE
JBLM WA
98433
US

IV. Provider business mailing address

2051 N ARABIAN RD
PALMER AK
98433
US

V. Phone/Fax

Practice location:
  • Phone: 253-967-1233
  • Fax:
Mailing address:
  • Phone: 907-750-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: