Healthcare Provider Details

I. General information

NPI: 1366415895
Provider Name (Legal Business Name): JAMES E SELF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 COMPASSION WAY SUITE 136
DODGEVILLE WI
53533-1956
US

IV. Provider business mailing address

800 COMPASSION WAY SUITE 136
DODGEVILLE WI
53533-1956
US

V. Phone/Fax

Practice location:
  • Phone: 608-937-7000
  • Fax: 608-937-7001
Mailing address:
  • Phone: 608-937-7000
  • Fax: 608-937-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34165-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: