Healthcare Provider Details

I. General information

NPI: 1225140460
Provider Name (Legal Business Name): JAMES P OFFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

2845 GREENBRIER RD
GREEN BAY WI
54311-6519
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8250
  • Fax: 920-288-8255
Mailing address:
  • Phone: 920-288-8250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34361
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number34361
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: