Healthcare Provider Details

I. General information

NPI: 1467486514
Provider Name (Legal Business Name): JAMES M BURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7137 236TH AVE STE 103
SALEM WI
53168-8975
US

IV. Provider business mailing address

7137 236TH AVE STE 103
SALEM WI
53168-8975
US

V. Phone/Fax

Practice location:
  • Phone: 262-843-4422
  • Fax: 262-843-1166
Mailing address:
  • Phone: 262-843-4422
  • Fax: 262-843-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42528
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: